Category: respiratory problems

Coupage is a form of chest physiotherapy that when performed correctly can be beneficial in loosening and removing excess secretions from the lungs. Many respiratory conditions result in an accumulation of secretions (also called mucous, phlegm, sputum) within the lungs that the patient cannot easily clear. This can result in difficulty breathing, poor gas exchange, collapse of lung segments and infection.

The lungs naturally produce mucous as part of their natural defence mechanism. When there is a chest infection, and occasionally with other conditions, the mucous increases and becomes thick and sticky. In the normal situation, these secretions are removed by coughing, but if the animal has lung disease or weakness, this is not always possible. The use of antibiotics can control any infection but they do not remove the secretions. Some will be absorbed naturally into the body but some will remain within the lungs.

Excess secretions provide a good environment for infection to develop as well as causing breathing difficulties. They block the airways and prevent the passage of oxygen from the inspired air to the blood stream, so having a detrimental effect on gas exchange. It is important therefore to remove the secretions to allow more effective and efficient breathing and increase the amount of oxygen getting into the body.

It is certainly possible for you to perform coupage on your pet as long as you have received training from an appropriately qualified veterinary professional. Coupage is a specialised technique. However, veterinary professionals will be adequately trained to perform it. In particular, chartered physiotherapists will have undergone extensive training in all chest physiotherapy techniques.

In many cases, coupage is more effective when used in combination with other techniques such as postural drainage and vibrations, and if appropriate you will also be advised about these.

• Hands should be formed into a ‘cup’ shape (with your fingers and thumb held closely together).
• Keeping your wrists loose you should flex and extend them whilst you gently pat your pet’s chest wall in a rhythmical manner. Your hands should pat the chest alternately, moving around the area being treated. Do not use too much force when performing this technique as the momentum developed in your wrists is sufficient, and too much force can be uncomfortable and may be detrimental to your pet.
• The coupage technique sends shock waves to the lungs which loosen the secretions and allow their transfer from the small airways to the larger airways where they can be cleared by coughing.
• Coupage can be performed using a one-handed or two handed technique and at a slow or fast speed, but you should be taught the correct technique for your pet by your veterinary professional.
• The technique should be performed through a sheet or thin towel to prevent too much stimulation to the skin. If your pet is small you can perform the same technique with 2 or 3 fingers from one hand.
• In most cases, coupage should be continued for 30 seconds to one minute. You should perform the technique continually during the advised time period.

• The hands are positioned on the chest wall over the affected part of the lung, and the chest is vibrated. During each vibration the hands gradually move towards the head end.
• Vibrations are only carried out whilst your pet is breathing out (during the expiration phase), so each vibration lasts for approximately 3-6 seconds.
• Generally 4-6 repetitions are carried out before allowing the animal a short rest period and then resuming coupage.

Postural drainage involves getting your pet into the best position to allow secretions to drain from the affected part of the lung. There are positions appropriate to all parts of the lung, and if appropriate you will be taught the postions that should be adopted for your pet.

When the techniques of coupage, vibrations and postural drainage are used in combination, the optimal chest physiotherapy regime is as follows:

Your pet should be positioned in its postural drainage position for 10-20 minutes, during which time the following should be carried out as in the example below:

• Coupage for 30 seconds to 1 minute
• Vibrations for 4-6 expirations
• Rest period of 1-2 minutes to allow drainage of the now loosened secretions
• Repeat several times over the 10-20 minute period*

*The number of repetitions, times, etc. will be determined by your veterinary professional (treatment is individual for the patient).

Coupage dislodges the secretions, vibrations move them towards the large airways, and the postural drainage position then allows the secretions to drain during the rest periods. Your pet may cough during its treatment, thereby clearing some of the mucous from its airways. It is common however for animals not to cough during treatment, but to cough 15-20 minutes later once they are walking around. Sometimes the secretions are swallowed rather than being coughed up, but at least they are out of the lungs.

Chest physiotherapy should never be done straight after a meal or drink, and you should wait at least one hour before starting the treatment.

Chest physiotherapy treatment involving coupage, vibrations and postural drainage should only be carried out when excessive secretions are known to be present. This may be once a day or it may be 4-5 times a day, but you will be advised on this. It is often more beneficial to do it after periods of rest (e.g. first thing in the morning) when the animal has been relaxing and the secretions have been draining naturally.

Performing these techniques on animals that have no secretions can be detrimental to that animal’s overall condition. Your pet should therefore be reassessed regularly during the treatment period, so you can receive updated guidance from your veterinary professional as to the appropriateness of continuing this therapy.

The trachea (also known as the wind pipe) is a tube that runs from the throat down into the chest where it branches to form the major airways in the lungs. The normal trachea is a soft tube that is held open by numerous rigid rings of cartilage. Coughing is the result of irritation or inflammation of the sensitive lining of any part or the airways or the lungs, and is an important protective mechanism allowing the removal of foreign material and mucus from the airway.

In young animals coughing is more likely to be caused by an infection, as a result of the dog inhaling a foreign body (such as a grass awn) or irritation due to smoke or other irritants. Some dogs have a congenital problem with their trachea which can allow the trachea to collapse and obstruct their airway so that they cough every time they get excited or pull on their lead. Brachycephalic dogs (those with short noses like pugs) may have long term respiratory problems that cause persistent or intermittent coughing.

In older animals other causes of coughing, such as heart disease and tumours, become more common. However, chronic bronchitis and other long term diseases reflecting damage to the respiratory tract over a lifetime can also develop in later life. A cough associated with chronic airway disease may be persistent but not get worse and your pet may remain bright and well otherwise.

Older dogs may also develop damage to the nerve controlling the vocal cords and these can obstruct their airway causing coughing particularly after eating, drinking or swimming if food and liquids pass into the airways instead of the oesophagus (the food pipe or gullet).

If your dog is coughing it is really important to get your vet to check them over to identify any possible causes that require treatment or to reassure you that nothing more serious is going on.

Some dogs with a cough may be completely normal in other respects, but this depends entirely on the underlying cause of the cough. In a young, otherwise healthy dog, kennel cough (infectious tracheobronchitis) is the most likely cause of cough. This usually gets better without treatment in 1 to 2 weeks but if coughing is persisting beyond this time or your pet is unwell you should seek veterinary advice. If you are taking your dog to the vet and think there is any possibility your dog may have kennel cough then it is advisable to leave you dog in the car until the vet has examined your dog, rather than risking potentially passing it to other dogs in the waiting room.

Dogs with pneumonia may have a fever, be off their food and feel pretty miserable. Nasal discharge may be present and this can be clear or snotty. Dogs with heart disease or lung problems may also have breathing problems and be unable to exercise normally. If laryngeal paralysis is present the changes to the vocal cords can cause changes in the tone of a dog’s bark (generally sounding hoarse), and exercise intolerance with some dogs developing blueness of the membranes (cyanosis) in their mouth or even collapse after exercise.

When presented with a coughing dog your vet will first want to establish some information which may help then localise which part of the respiratory tract is affected. Questioning you about the nature of the cough (whether it is dry or moist, intermittent or always present) will provide valuable information so it is important you think about the circumstances in which your dog coughs before you attend the veterinary visit. If you are able to take a video clip of your dog coughing on your mobile phone this may help your vet further. Your vet will want to examine your pet and look for any other signs of illness such as fever which may give a clue as to the cause of the cough. By listening to your dog’s chest with a stethoscope your vet will be able to assess heart and lung health. There are many diseases that can cause chronic coughing and your vet will want to rule out the more serious causes of coughing before a final diagnosis is made.

Investigation of coughing involves X-rays of the trachea and the chest and your vet may want to pass an endoscope (a small tube with a camera on the end) through the trachea and down into the lungs to take some samples; these are usually washes to look for inflammatory or cancerous cells, and to provide material for culture.

The treatment of coughing varies greatly depending on the cause. In some cases, if the cough is not too severe, no treatment may be necessary. Medical treatment may be available for coughing related to heart disease and infectious causes of cough. Rarely, if more sinister disease such as cancer is present, other treatment options willbe considered. It is important not to administer human cough medicine to your dog without veterinary advice.

Over the past hundred years human beings have designed for themselves a huge number of different dog breeds. The conformation of some of these breeds has become more extreme and sadly many health problems have been introduced into the dog population as a consequence. The continual increased selection pressure for ‘desirable’ physical traits has resulted in many pets presenting with more severe manifestations of certain congenital conditions and at a much younger age.

Brachycephalic upper airway syndrome otherwise known as BUAOS arises from the effects of a group of congenital anatomical defects present in brachycephalic breeds. Brachycephalic breeds of dogs are those with characteristically short noses such as the Pug, Boston terrier, English and French bulldog and Pekingese. Animals with shortened noses still have the same amount of tissue in their nose and throat but this is squashed into a smaller space which causes folds and wrinkles that obstruct the airways. Animals with BUAOS may have one or more of the following defects:

• Excessively long and thickened soft palate.
• Narrowed laryngeal lumen caused by protruding laryngeal saccules.
• Collapsed larynx.
• Stenotic nostrils.
• Excessively narrow trachea, especially common in bulldogs.

The abnormal anatomical conformation of these dogs means that airflow through airways is impeded resulting in noisy breathing and an inability to take on board sufficient oxygen to meet increased demands imposed by exercise. The nasal cavity has a huge surface area covered by richly vascularised tissue that in normal dogs cools inhaled air thus forming an important part of the body’s mechanism for temperature regulation. This is compromised in brachycephalic breeds and many breath through their mouth bypassing the nasal cavity altogether.

This explains why many of these breeds have poor heat tolerance and cope poorly with hot weather. Hot weather also causes swelling of the tissues in the nose and throat further impeding airflow and exaggerating symptoms.

Severely affected dogs may show signs of breathing problems at a very young age (4-6 months of age) although most will present with signs at around 1-3 years of age. The first signs you may notice if your dog has BUAOS are that it has noisy breathing or may snore loudly whilst sleeping. In fact many owners of dogs with short noses such as pugs and bulldogs think it is normal for their pets to snore and snuffle. However, these noises indicate that their pet’s airways are already narrowed and breathing is difficult. Dogs with BUAOS frequently have significantly disrupted sleep as every time they lie down and relax their airways become obstructed.

Many dogs with BUAOS are unwilling (or unable) to exercise normally and this can predispose them to putting on weight which further exacerbates their problems. Sudden deterioration in breathing may develop, leading to respiratory distress or sudden collapse (particularly in hot weather). This deterioration may be brought on by exercise and excitement. Severely affected animals may have almost total airway obstruction and can develop fluid build-up on the lungs. Animals that have severe bouts can die rapidly if they do not get emergency veterinary treatment.

When dogs are hot they cool themselves by panting. When they pant they move air back and forth over their hot airways and thus evaporate water and lose heat. Dogs with BUAOS are unable to move air through their airways efficiently which prevents adequate heat loss through panting. Dogs with BUAOS are at particular risk of over heating in hot weather, following exercise or when under stress.

The diagnosis is based on the clinical signs (and typical breed) but further examination may be required to confirm the diagnosis and rule out other conditions. If your vet suspects that your dog is suffering from BUAOS they will want to perform a detailed inspection of the upper airway with your dog under anaesthesia and may pass an endoscope (containing a small camera) through your dog’s airways so they can access which abnormalities your dog has and how severe each of these is. These examinations are best performed by a veterinary surgeon experienced at treating this condition so that treatment can be carried out at the same time. Anaesthesia and examination without correction poses unnecessary risk to your pet.

There have been many reports suggesting that brachycephalic dogs often have difficulty or experience pain on swallowing and some may regurgitate or vomit frequently. This may be due to reflux of fluid from the stomach but many brachycephalic dogs also have anatomical defects in the gastrointestinal tract. Some examples of these include: hiatal hernias (where part of the stomach passes through a larger than normal hole in the diaphragm into the chest), and pyloric stenosis (where the stomach exit is narrowed preventing food from leaving the stomach normally).

Always make sure you give your vet a full history of all your dog’s problems even if you think one (like breathing difficulties) is more important. In many cases treatment of the airway problem with improve the gastrointestinal symptoms but more severely affected patients may require additional medication.

Most animals with BUAOS will be improved if they lose weight, so a dietary regime forms part of any management.

Because BUAOS is caused by congenital abnormalities of the airways the only way to resolve the problems is to correct the underlying abnormalities. Surgical procedures can open up the nostrils and remove excess tissue within the airways that is restricting airflow. Surgical correction requires a great deal of skill and is not without risks. Your vet may choose to refer you for treatment to a surgeon who specializes in these procedures.

Following surgery, the lives of affected animals should be significantly improved. Correction of the reversible primary abnormalities early in life will slow down or potentially prevent secondary irreversible changes occurring that would otherwise compromise the airway further. This emphasizes the importance of critically evaluating how well your pet can breathe early in life and seeking professional advice.

Since the condition is inherited it is important not to breed from animals that suffer from BUAOS (even if they have had surgery) as their offspring will also be affected. Unfortunately most show animals in affected breeds have been deliberately bred to produce the external appearances that are the result of these defects (such as a very short nose and flat face) so the defects are present to a greater or lesser extent in all animals within the breed.

Ultimately BUAOS is a significant welfare issue in brachycephalic breeds and the only way this can be alleviated is by breeder acceptance that extreme conformations (such as excessively short noses) are not desirable in dogs.

If your dog is registered with the Kennel Club and has had correction of any conformation abnormalities associated with BUAOS please notify the Kennel Club that these surgical procedures have been performed.

If you are worried about your pet in any way, but especially if it appears to have breathing problems, then you should contact your vet for advice.