Aspiration Pneumonia | Dr. Justine Lee
If your dog or cat was just diagnosed with aspiration pneumonia, read on! This is a potentially life-threatening emergency that warrants an immediate trip to your veterinarian or emergency veteriarian for oxygen therapy and treatment.
Aspiration pneumonia is the condition when gastrointestinal contents have been inhaled into the lungs. This results in a secondary inflammation and infection of the lung. Due to this inflammation, excessive fluid and mucus accumulates within the lower airway, causing difficulty breathing.
Dogs that develop aspiration pneumonia typically have a history of: 1,2
- Recent anesthesia or sedation
- Vomiting
- A diagnosis of an underlying medical condition that predisposes the dog towards aspiration
- Neurologic problems
Medical conditions that make a dog more likely to aspirate vomitus into their lungs include: 1,2
- Laryngeal paralysis
- Megaesophagus
- Persistent right aortic arch (seen in puppies)
- Congenital esophagus problems
- Gastrointestinal disease
If your dog had recent sedation or anesthesia for surgery, has an underlying medical condition that predisposes it to aspiration, or gets sick after vomiting, he or she may have aspiration pneumonia. Clinical signs of aspiration pneumonia include:
- Not eating
- Coughing
- Fever
- Lethargy
- Panting
- An increased respiratory rate
- Exercise intolerance
- Open mouth breathing
- Noisy or wet breathing
- Blue-colored gums
- Stretching of the neck out to breath
- Weakness
- Collapse
Diagnosis
The diagnosis of aspiration pneumonia in dogs typically starts with a thorough physical examination by your veterinarian (including careful auscultation with a stethoscope for abnormal lung sounds). Additional tests to diagnose aspiration pneumonia include:
- Chest x-rays
- Abdominal x-rays (to look for the cause for the vomiting)
- Baseline blood work to make sure the kidneys, liver, and other organs are working appropriately and to see if the white blood cell count is elevated
- Pulse oximetry or an arterial blood gas to measure the oxygen level within the lungs or blood.*
* NOTE: A normal pulse oximetry reading should be > 95%. Anything < 92% requires oxygen therapy, as it means the blood oxygen saturation is very low!
Sometimes, a transtracheal wash or endotracheal lavage are necessary to diagnose the underlying bacterial infection within the lung. This is a “fluid wash” where fluid is flushed into the lung and aspirated back for culture testing. This is often important to help rule out other
causes of pneumonia, such as other bacterial causes (e.g., kennel cough pneumonia secondary to Bordatella bronchiseptica), fungal causes (e.g., Blastomycoses), or even cancer.
Treatment
If you notice any of the clinical signs of aspiration pneumonia, immediate treatment at your veterinarian is necessary. Treatment includes oxygen therapy, intravenous (IV) catheter access, IV fluids, and IV antibiotics. Additional therapy may include anti-vomiting medication (e.g., maropitant), nebulization and coupage, and lung expanders (e.g., bronchodilators). Once your dog is more stable, diagnostics such as blood work and x-rays should be performed.
Treatment should not include diuretics (e.g., water pills) that can dehydrate the patient or cough suppressants (which can prevent the pus in the lungs from being coughed up). Also, drugs that suppress the immune system (e.g., cyclosporine, prednisone) typically should not be used as it can prevent the body from fighting the infection within the lung.
Once a dog can breathe without the support of oxygen therapy, treatment at home includes antibiotic therapy for 3-5 weeks. Frequent recheck veterinary examinations should be performed to make sure the pneumonia is resolving – this will include recheck chest x-rays approximately once a week for several weeks. Oral antibiotics should be continued for one week past the resolution of abnormal x-ray patterns.
Thankfully, the prognosis for aspiration pneumonia is good, with an average 77-81.6% survival rate.1,2 However, this can be a significant complication of even elective surgery, and can add significant costs due to hospitalization and treatment.
References:
- Kogan DA. Johnson LR, Sturges BK, et al. Etiology and clinical outcome in dogs with aspiration pneumonia: 88 cases (2004-2006). J Am Vet Med Assoc 2008;233:1748-1755.
- Tart KM, Babski DM, Lee JA. Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005-2008). J Vet Emerg Crit Care 2010;20(3):319-329.
As previously published on www.PetHealthNetwork.com.
Photo by Tambako The Jaguar // cc
Hi I used to do your facials at the spa in St. Paul. Jocelyn. My old SHITZU had dental surgery and now has it I’m doing everything they say. Please tell me he will be ok
Hey Jocelyn! I hope you are doing ok! If your dog isn’t in oxygen, the prognosis is pretty good provided he’s on antibiotics. Is he breathing ok?
My puppy has a very bad case of aspiration pneumonia. He is in an animal hospital and getting the best treatment possible. My question to you is even though he’s getting anabiotic’s and supplements and humidifiers And oxygen I’m still worried because he hasn’t eaten and nine days now. His pneumonia so bad that when they took a chest x-ray there was hardly any black in it signifying the oxygen levels he has. There is hardly any black and they told me that means there’s hardly any oxygen and his case compared to a healthy dogs x-ray where there is a lot of black representing the oxygen level. Can he survive without eating? It’s been nine days and I’m so concerned I love him so much. I believe this was on my phone because he had Giardia and wasn’t eating and they wanted me to give him his medication in a syringe. He didn’t want it and I forced him and now he’s paying for it.
I’m so sorry to hear this! If he’s losing weight, your clinic can consider putting in a temporary nasoesophageal or nasogastric feeding tube, but as long as his blood sugar is ok, I’m not too worried as long as he’s stable. Talk to your vet about it however. Thinking of you guys and hope he heals well – keep me posted!
Hello Dr. Lee,
Our Siberian Husky, Meeka has been battling pneumonia (aspiration) for 8 months now. She also has laryngeal paralysis. She is currently on prednisone, baytril, clavamox, antacid, and cisapride. She has had a bronchoscopy, nasal flush, and probably a few other tests or procedures I am forgetting. They are encouraging us to get done a CT scan, biopsies, and I think another test or two with the cost of about $3,000. We are working with our regular vet and Michigan State University. Still no one knows the root cause of the pneumonia. Wondering what your thoughts are? Meeka is our world and we desperately want her to become the healthy dog she once was again.
That’s so frustrating – how old is she? Laryngeal paralysis is inherited in sled dogs and so if she has laryngeal paralysis, that itself can result in the pneumonia. As it likely won’t change her diagnosis (which is treatment for the pneumonia), I’m not sure if CT scan is necessary UNLESS they think her pneumonia is NOT from the laryngeal paralysis. Talk to them again and see if they are concerned about something else besides the laryngeal paralysis causing the pneumonia.
If she is symptomatic from the laryngeal paralysis (difficulty breathing, etc), she needs to have that surgically corrected….but that can increase the risk of pneumonia.
I’m so sorry and please keep me posted! Thinking and praying for Meeka!
I think we may have lost our little Pommie, Athena to aspiration pneumonia. She had a mouth infection, her teeth were really bad despite having a anesthetic free dental back in June, so she had to undergo anasthesia they pulled several teeth,and even had to sew her gums due to some lesions possibly because she had kidney issues and that was a side effect according to our vet. We brought her home a week ago Friday night and although I know her mouth was painful she refused to eat even boiled chicken on Sunday, was lethargic and had rattled breathing. We brought her back to the vet to be monitored two days in a row and upon the second day her condition was worsening and she had eye and nose discharge. We ended up having to put her to sleep which just continues to break my heart. Looking back I really think she contracted pneumonia from the surgery, but I can’t prove it since she had so many other health issues.
I’m so sorry to hear this – it’s hard to tell it it was from congestive heart failure or pneumonia, etc. It sounds like she had a lot of underlying problems which is so hard. I’m not sure if your veterinarian offered to transfer her to a specialty hospital with 24 hour oxygen or not, but that may be an option if she had severe difficulty breathing. I’m so sorry for your loss…
I am currently fighting aspiration al pneaumonia that developed after a tie back surgery in my 13 year old irish setter. He was hospitalized for a week with iv, ocygen therapy and now is home. I can he is on two abtibiotics but I am having almost no lick getting him to eat. Any suggestions?
Try Gerber meat-based baby food or even chicken breast? I would check in with your veterinarian and let them know!
My dog was recently at the vet for an ongoing breathing issue. At first they thought it was allergies & when those meds didn’t do well, I showed them a video of him breathing on a walk & they said it was likely asthma. They prescribed 1/4 tablet of Theophyline & 1/2 tablet of Prednisone. Later that day, he threw up & was in distress. I rushed him to the ER vet who said he was within minutes of suffocating. He had asphyxia pnemonia. After a few nights stay in an oxygen chamber with meds…he came home to recover on antibiotics and tranquilizers. The dr there said he likely has classic COPD. He has had all the symptoms prior to the vomiting episode. The ER Dr wants to do a transtrachial wash of his throat . Is this a necessary procedure? Ive spent thousands already & it seems after that procedure, there could be more if there is no diagnosis. Can’t we treat the pneumonia & give a bronchial inhibitor for COPD to try before all the other testing?
Would you recommend a low dose steroid if all the bloodwork is fine and the dog is just having trouble when oxygen drops below 30%? Would a low dose steroid cause any harm at this point?
Also, what about a diuretic to help clear the lungs? Is this safe or effective while the dog is receiving IV fluids?
Evidence has shown that steroids or diuretics don’t help with aspiration pneumonia unless it is due to an underlying cause (e.g., chronic canine bronchitis, heart failure, respectively).
Comment *i have a 11 week old kitten with pneumonia in 3 areas. She was off oxygen for 18 hours And then had to go back in. They can not taper her off with out her respiratory rating going to 60. Dr said she is eating, playing, purring, her blood work and glucose are fine. She has been in for 4 days on fluid and antibiotic. They are adding a secondary antibiotic today. Can anything else be done. If I bring her home and keep her nebulized will that give her the time she needs to recover or is 60 respiratory rate just to high to survive?
Comment* How soon after vomiting would a dog show signs of aspiration/aspiration pneumonia? Wondering how long I need to be watchful for symptoms.
Sometimes if it’s severe, the signs can be ACUTE, but otherwise it’s often a few days after.
Hi Dr. Lee, my 10-month-old husky has had recurrent nasal infections starting from 7 weeks old and has had aspiration pneumonia 3x already within the past 4 months. We have spent countless hours at the emergency/speciality clinic that we are ‘regulars’ over there. Rhinoscopy + nasal culture yielded no significant findings and now, the internist is suspecting primary ciliary dyskinesia or GI-related issues. Even with all of her respiratory issues, she hardly shows signs of breathing distress when we’re on walks or when she has her zoomies. She goes from being the typical energetic husky to being lethargic/listless within hours when the deep cough comes back in. We were going to do diagnostic testing for PCD, but after finding out that it will not help with any treatment options and that there is a high chance of false negatives, I decided not to go forward with testing. I do want to see if it is related to GI-issues and was going to test for those; however, puppies with GI-issues don’t have frequent nasal infections as a concomitant condition.. right? Can you tell me wha you think we should do? We’ve have 2 internists, 2 critical care doctors, and 2 primary care doctors working with us now and are still having difficulty. Thanks in advance.
Oh man, I’m so sorry to hear that. It sounds like you’ve done such an extensive work up. It’s weird it’s occurring at such a young age – likely more congenital like you mention. However, has a bronchoscopy been done or endotracheal lavage? No change it’s an eosinophilic bronchopathy and needs steroids? That it’s not fungal? (there is a urine test for certain fungal infections, depending on where you live)? Dr. Lee
Hi Dr. Lee, my 11 yr old. corgi was just diagnosed with aspiration pneumonia. He had vomited early this morning, and must’ve accidentally inhaled some food/water because his breathing became labored immediately after. After we took him into the vet for xrays, the vet told us it was aspiration pneumonia, gave him some anti nausea meds, and sent us home with a few antibiotics.
Since he’s been home (12 hrs now), his breathing hasn’t really improved… Its still labored, but I’m assuming that if the vet allowed him to come home, his case of AP must be manageable… He hasn’t been eating, but still drinks water. He’ll do a deep cough occasionally.
I was wondering if this behavior was normal (the constant heavy breathing) and when we might expect him to improve after we give him the antibiotics. Is the coughing a good sign that he’s trying to get the fluids/particles out of his lungs? He’s just been lethargic and laying in his bed, having difficulty sleeping. Should I prompt him to cough more? Or just leave him to recover in peace? Thank u so much for your help… I’m glad I stumbled across this post.
Oh no. If he’s still having labored breathing, I’d bring him to an emergency or specialty clinic for 24/7 oxygen. He also sounds like he needs anti-vomiting medication, IV fluids, oxygen, nebulization and coupage. While home, you can humidify his room that he’s in, or bring him into the bathroom when you take a hot shower for the steam. (Not in the shower with you). I would bring him in for x-rays, blood work and oxygen right away! Please keep us posted! Sending him love and good thoughts. I hope that helps!
He had blood work done a week ago (for his annual check up) and xrays/anti nausea meds yesterday when I took him in when his AP had just started. He made it through the night! and FINALLY took some food this morning. Breathing is significantly less labored but still on the shallow side. He’s still drinking water regularly.
Hasn’t had one of his coughs in a while. Fingers crossed for my little dude!
Hi Dr. Lee, My 12 yo Maltese developed pneumonia in August with 3 nights in the ICU with two types of antibiotics for a month. They are not sure why he developed it. I am wondering does the severity of pneumonia get worse if he encounters another episode? Thank you.
It’s typically if there’s aspiration or inhaling vomiting. Sometimes, it’s infectious from other causes (Canine Infectious Respiratory Disease) or underlying cancer, bleeding, etc.
Thank you so much. Will it be more dangerous if he gets another episode? I know in human if you get pneumonia multiple times the chance of surviving it is reduced. Same with dogs?Comment
Hi,
My Saint Bernard was hospitalized for suspected aspirational pneumonia on Thursday. Her breathing and heart rate have returned to normal and she is now getting up and walking around on her own. However, she is epileptic and is on a slew of meds to treat that, all which make her nauseous taking them on an empty stomach. She will not eat and they have her on a feeding tube currently but she keeps regurgitating. She can’t come home yet until we have a way to feed her. The vet has suggested a gastronomy tube or PEG tube, the risks to my dog that are involved in this are ones I’m not willing to take. Do you have any suggestions they might be over looking to get her to eat on her own? They’re concerned her esophagus is enlarged and is part of the problem.
Also worth noting she has a UTI and thyroid test came back a bit irregular so they want to treat this too.
Any suggestions are greatly appreciated.
Oh, I’m so sorry to hear that. Is she on an appetite stimulant (Entyce) and an antivomiting medication too?
I know they tried the appetite stimulant with no luck and she is getting an anti-nausea med and they have now started her on some anti-acid meds.
Hi Dr. Lee,
My pup went in for surgery and aspirated as they took out the ET tube. They said to look out for breathing issues but hopefully he is okay. My question is, for people, when they go into surgery, it is anesthesia’s job to prevent this and if the patient acquired infection while under their care, the hospital pays for treatment. Is this true of vets as well? I’m worried for my pup.
Being that you have human health insurance that covers anything, this is totally different. Unfortunately, aspiration pneumonia is a rare but potential complication that can occur from any anesthesia or sedation.
Hi Dr. Lee,
we had a Great Dane x Mastiff rescue dog, he was just barely 2 years old.
we have just said good bye to my best friend 2 days ago, for about 2 months he was on and off with vomiting but he was still active, eating and going to the toilet fine so we were advised to keep an eye on him and it went away after a couple days, then about 4 weeks ago he started vomiting again so i made an appointment for a checkup and they suspected an ulcer and gave me tablets but i demanded an xray be done, fast forward to when we were able to get in and the night before he devoleped a cough, while under the xray they discovered he had Megaesophagus, and because of his vomiting he had Aspiration Pneumonia and said that she doesnt think he will make the weekend so i made the hard call and i retrieved his family and we said our good byes.
now i am beside myself as the day before he was up and about still, and i feel like i have made the wrong decision in not letting him have a fighting chance, i cannot get the thought out of my mind that i failed him.
i know it is hard to say as you do not know his full story but i guess what i am asking is, did i do the right thing?
Comment *hi my senior dog in at the hospital with. severe pneumonia. He’s been in the oxygen cage for 2 days now. He’s stable, but not improving. He’s breathing is still labored. He had a little chicken last night. What do you recommend? He’s my entire life.
Comment *his oxygen levels are between 92-95
I would continue with therapy at a 24/7 specialty facility as needed for therapy – the good thing is that his oxygen level is decent at 92-95%! Best of luck and keep us posted!
Comment *im heading there now. He’s 17 years old. He’s my baby