The 3 most common causes of cough in cats are: asthma, chronic bronchitis and heartworm associated respiratory disease. Other possible causes of cough in a cat include infectious causes such as pulmonary parasites, fungal infections, bacterial infections, viral infections and protozoal infections. Occasionally cough is due to fluid accumulation around the lungs: either infection fluid or chylous fluid. These fluids not only can affect breathing but also cause a cough due to the thick viscous nature of these fluids and the irritation it causes the lining of the chest cavity.
Uncommon causes of cough in cats are due to lung tumors, heart failure and hairballs.
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Why is my indoor cat coughing with no hairball?
One frustrating feature of coughing in cats is that many owners can find it hard to recognize a cough in a cat. They often attribute the cough to retching, gagging , or trying to have a hairball .
If you notice your cat coughing like he’s bringing up a hairball, but no hairball comes up, this is most likely true coughing. Cats are not coughing when they are bringing up a hairball.
What coughing in cats looks like:
When a cat is coughing, they will often crouch on all four legs with their neck outstretched. Their cough will look as if they are about to bring up a hairball as they forcefully expel air out of their chest several times over. Cats may lick and swallow shortly thereafter to swallow phlegm and salivary secretions that they have coughed up. The most common cause of cough in cats is due to asthma.
Fritzthebrave.com is a website dedicated to Fritz, a cat with asthma. The video below shows what asthmatic coughing looks like in Fritz.
http://www.fritzthebrave.com/gallery/inhaled.php
How can I help my cat with a cough?
Treating a cat with a cough relies first on identifying the cause of the cough. The cause of a cough in a cat is based on the history of the cough and diagnostics such as chest X-rays as recommended by your veterinarian. Your veterinarian will want to know if the cough is seasonal, if it occured with symptoms of an upper respiratory infection, if it is chronic, if the cat is an outdoor cat or indoor only cat etc. Diagnostics recommended by your veterinarian often include imaging of the chest with X-rays and sometimes blood tests and fecal exams.
How to treat cat asthma
If your cat is diagnosed with asthma, treatment has a three pronged approach:
- minimize environmental aeroallergens
- reduce airway inflammation
- reduce/prevent bronchoconstriction.
The mainstay of treatment for asthmatic cats is reducing inflammation with an inhaler. The inhaler is used to deliver daily doses of an inhaled steroid. In acute airway crises, an inhaled bronchodilator can be administered.
The most common inhaled steroid used in cats is called flovent (fluticasone propionate) and the most common inhalant bronchodilator for rescue therapy is albuterol. Unless a cat has some respiratory distress as part of their asthma, a bronchodilator like albuterol is not alway used.
There are few recommendations to minimize indoor aeroallergens:
I recommend you use an air purifier that uses a HEPA filter in the room that your cat prefers to spend time in.
You can also change your cat’s litter to a low dust litter such as Dr. Elsey’s Respiratory Relief litter.
How do you use an inhaler in cats?
Inhaled steroids are the safest way to use steroids to treat asthma in cats. This is because the medication is delivered directly to the lungs. This means there is less systemic absorption of the drug and fewer side effects from the medication. In fact, I’ve never seen side effects from using an inhaled steroid.
In order to use an inhalant medication in a cat you need a delivery system. The delivery system I like best is an Aerokat chamber. An Aerokat is like a pediatric chamber for kids, but the mask is better suited for the snout of a cat. The other end of the chamber is designed to attach the inhaler. When the medication is dispensed from the inhaler, the medicine is aerosolized into the chamber. As your cat breathes in and out, the medication in the chamber is inhaled into your cat’s lungs. The one way valve ensures the medication is only able to travel one direction. The valve also serves as a handy way to watch the number of breaths your cat takes. It is best to keep the Aerokat on your cat for a full 10 breaths or at least 20 seconds.
PRO TIP: you can fit the inhaler to the end of the Aerokat chamber and puff the inhaler into the chamber away from your cat. This way, you can avoid spooking your cat if they are nervous with sudden loud hissing sounds. Treat your cat immediately after applying the mask for the recommended amount of time.
Similar to feline asthma, chronic bronchitis is managed with long term anti-inflammatory mediation (best as an inhaled glucocorticoid) and reducing inhaled irritants. One of the key differences is that chronic bronchitis should have no airway spasm caused by aeroallergens. Cats with chronic bronchitis rarely have bronchoconstriction or respiratory distress because they don’t react the way asthmatics do.
Management of infectious causes of respiratory disease and cough is dependent on the infection present. Pulmonary parasites are typically treated within 10-21 day of a dewormer like fenbendazole. Heartworm associated respiratory disease is the most challenging to treat and the therapy is aimed at reducing airway inflammation with anti-inflammatories and starting regular heartworm prevention.
Bacterial lung infections are treated with antibiotics and viral infections are treated with supportive care (hydration, enticing your cat to eat, and steam inhalation if needed to moisten the airways).
Infectious diseases that cause coughing in cats:
Feline heartworm disease
The most important infectious cause of cough in cats is due to heartworm disease. On X-ray, the lung will have a diffuse bronchial and bronchointerstitial lung pattern which can look exactly like asthma or chronic bronchitis. The differentiating tool is a heartworm antigen and antibody test performed on blood. Almost 10% of indoor-only cats are positive for heartworm! In areas of the country like Texas, 25 % of indoor only and indoor outdoor cats had heart worms. It is recommended to test all asthmatic cats for heartworm.
Feline lungworm disease
A fecal exam should be performed on all coughing cats to pick up possible infectious causes such as feline lungworm. Lungworm infections can occur when a cat eats a slug or snail infected with the lungworm larvae or eats an intermediate host infected with the larvae (rodent, bird, frog or lizard ).
The larvae then migrate from the digestive tract to the lungs in about 5 weeks. Once migrated to the lungs, the lung worms induce a lot of lung inflammation and irritation. This causes coughing and other more severe respiratory signs like fast breathing and trouble breathing may be seen. Diagnosis is via a fecal evaluation of identification of the L1 larvae in the stool. Treatment is with fenbendazole.
Feline fungal lung infections
If you live in certain areas of the country where fungal infections with histoplasmosis and blastomycosis are common, fungal antigen testing is important. Although fungal lung infections can cause a more nodular x-ray pattern, a diffuse bronchointerstitial or interstitial pattern more characteristic of asthma/bronchitis does necessarily rule out fungal infection.
How long does feline bronchitis last?
Chronic bronchitis has similar symptoms as feline asthma and x rays of the chest look similar too. However, cats with chronic bronchitis should not have any respiratory distress as part of their presentation. These guys just have chronic cough of over 2 months. There should not be any observed “trigger” or seasonal component. There may be some cyclic changes just based on current issues with the cat. Formal diagnosis of chronic bronchitis is based on a bronchoalveolar lavage (airway wash which shows inflammatory cells of >7%neutrophils) and a negative bacterial culture. X-rays should show prominent airway markings and negative infectious disease tests (testing for fungal, bacterial, viral, parasitic and protozoal causes)
Acute bronchitis is most often from a viral or bacterial airway inflammation. Viral causes are most often flare up of a herpes virus. Bacterial infection may be from mycoplasma which causes upper respiratory infection with some extension into the lower airways. Symptoms commonly last 7-14 days.
Differentiating chronic bronchitis from asthma in cats
| Disease | Feline bronchitis | Feline asthma |
| Age at diagnosis | Young age or older age | Young to middle age |
| Sex | Either sex | Females over-represented |
| Breed | Any breed | Siamese are over-represented |
| Symptoms | Majority have daily cough Respiratory distress only occurs in end stages | Episodic respiratory distress Increased abdominal component to breathing Some paroxysmal coughing |
| Response to fast acting bronchodilator | Minimal response | Rapid decrease in respiratory distress |
| Chest XRays | Not likely to see hyperinflation of lungs | Likely to see hyperinflation of lungs |
| Lower airway cytology | Mostly chronic inflammation | Mostly allergic inflammation |
Is a cat coughing an emergency?
If your cat is coughing sporadically and otherwise acting normally, the coughing is not an emergency. It is best, however, to schedule an exam with your veterinarian in the near future for evaluation. Sometimes a cat can have a bout of asthma or other condition that requires emergency treatment. If your coughing cat is breathing hard (they are moving their belly to breathe), open mouth breathing, or breathing very quickly (over 40 breaths per minute is an elevated respiratory rate) they should be seen immediately by a veterinarian. A typical respiratory rate for a cat is 16-30 breaths per minute. Most cats struggling to breathe have respiratory rates above 60 breaths per minute. If your cat is not eating much or if they are hiding or extremely lethargic, you should have your cat evaluated.
Types of cough based on location in the respiratory tract:
When your cat is being evaluated for a cough, there are three main areas where the issue may be arising: the oropharynx (the back of the mouth/throat area), the upper airway (nose and wind pipe) and the lower airway (the lungs).
Oropharyngeal disease can produce a rattly sounding cough with retching, obstructive breathing pattern with difficulty breathing in and voice changes. Examples of oropharyngeal disease that can produce a cough include: pharyngitis, foreign bodies, nasopharyngeal polyps, cancer, and trauma.
Upper airway disease that can produce a dry harsh cough with obstructive breathing pattern, voice change, stridor trachea. Examples: laryngitis, tracheitis, foreign body, cancer, and laryngeal paralysis.
Lower airway disease can produce wheezing, possible obstructive airway breathing with abdominal effort to breathing, and a harsh cough. Examples can include: asthma, bronchitis, foreign body, cancer, and bronchiectasis (dilated lower airway tubes).
Cat coughing and gagging, particularly after eating and drinking:
Cats that cough and gag may actually have a problem in their larynx or possibly their esophagus. Laryngeal disease is uncommon, but can be a cause of upper airway obstruction in cats. The two most common causes of laryngeal disease in cats are tumors of the larynx and paralysis of the larynx.
Laryngeal paralysis causes impaired movement of the arytenoid cartilages . These cartilages should abduct (open) and close like shutters over the larynx. If the enervation is no longer functioning, they remain in the “closed position” . Causes can be due to cancers in the area, a generalized neuromuscular weakness disorder, or possibly a congenital thyroid cartilage malformation. Most commonly, this disease will also present with a voice change.
Other symptoms can include stridor (higher pitched inspiratory difficulty) , trouble breathing, decreased appetite and lethargy. Esophageal disorders such as megaesophagus causes a dilated and flabby esophagus. The normally toned muscular tubing becomes flaccid which causes food to no longer be properly pushed down the esophagus.This may cause coughing and passive regurgitation of the food back up. Gastrointestinal reflux in people can cause coughing but this is rarely seen as a complication of reflux in cats. The more common symptoms would be drooling trouble swallowing and regurgitation.
What should I do if my cat is coughing: home remedies
If your cat is coughing at home with evidence of nasal congestion you can have your cat inhale steam in a bathroom from a hot shower. Have them breathe in steam for about 10 minutes twice a day to help loosen the mucus in their nose and lower airways.
If you see a lot of sneezing and thick nasal discharge consistent with an upper respiratory infection, you can also try loosening the mucus in their nose by instilling 1-2 drops in each nostril of a sterile saline solution like Little Noses as needed.
If you suspect a seasonal cough in your cat, you can try an oral antihistamine like (chlorpheneramine 2mg (½ of a 4mg tablet ) twice a day.
If you suspect your cat has asthma, you can try an air purifier and low dust litter.
Will my cat’s cough go away on its own?
A cough that is more sudden in onset and paired with symptoms of an upper respiratory infection will likely go away in time. As long as your cat is eating normally and not acting lethargic or having trouble breathing, it will probably resolve in time.
A cough that is sudden in onset and seasonal in nature with sporadic bouts of coughing may improve as the air quality changes.
Any cough that is more chronic/persistent or any cough paired with symptoms of trouble breathing or loss of appetite or energy should be evaluated by your veterinarian more quickly.