Feline asthma: inhaled fluticasone vs oral prednisolone — POSSIBLE

In cats with asthma (chronic bronchial disease), does inhaled fluticasone via chamber vs oral prednisolone control airway inflammation and clinical signs equally?

Shelf #363 · gate-verified and approved by the developer

POSSIBLE: In the only trial in cats with naturally occurring asthma — a randomised pilot of just 9 client-owned cats — inhaled fluticasone and oral glucocorticoid both left all cats clinically normal with significantly improved airway eosinophilia at 8 weeks, and neither improved radiographic changes; only the oral group showed decreased airway resistance, though the inhaled group started with higher baseline resistance. The experimental-model literature points the same way: in an acute Ascaris suum model, high-dose inhaled fluticasone (alone or with salmeterol) inhibited allergen-induced airway hyper-responsiveness like oral prednisolone, with bronchoalveolar eosinophil percentages significantly lowered by prednisolone and the fluticasone-salmeterol combination; and in the Cohn/Reinero experimental model, inhaled fluticasone at 44, 110 or 220 µg twice daily reduced airway eosinophilia by 74%, 82% and 81% respectively with no hypothalamic-pituitary-adrenal suppression at any dose. Anchor correction: the draft's 'Venema et al. 2010' is a narrative review of feline asthma (PMID: 20800209), not a trial, and is not carded as evidence; the genuine Cohn et al. 2010 record is the experimental dose study carded here. Most of this literature is experimental/asthma-model rather than client-owned cats, which — with a 9-cat pilot as the only natural-disease trial — caps this shelf at POSSIBLE. Drafted Nov 10, 2026 (VetMed build, topic #363); all figures from abstracts fetched and verified at drafting.

Verschoor-Kirss 2021: in 9 cats with naturally occurring asthma, inhaled fluticasone and oral glucocorticoid both normalised clinical signs and improved airway eosinophilia at 8 weeks

Randomized pilot trial (record's own title wording; publication types include Randomized Controlled Trial, Veterinary)

Who: Cats: 9 client-owned cats with naturally occurring asthma, enrolled on clinical signs, thoracic radiographic findings and airway eosinophilia, randomised to oral glucocorticoids (n = 4) or inhaled glucocorticoids (fluticasone; n = 5), the inhaled group also receiving a 7-day overlapping course of oral glucocorticoids at the start; evaluated at baseline and 8 weeks with thoracic radiographs, bronchoalveolar lavage, lung function testing and fructosamine levels.

Result: All cats were clinically normal after treatment and had significantly improved airway eosinophilia and decreased nucleated cell count. No improvement was seen in radiographic changes after treatment with either therapy. Oral, but not inhaled, glucocorticoids caused a decrease in airway resistance, although cats in the inhaled group had a higher baseline resistance than those in the oral group. Fructosamine levels did not change with treatment.

Watch out: This is the only carded trial in naturally occurring (client-owned) disease and it is a 9-cat pilot — far too small to establish equivalence, and the record does not state that assessors were blinded, so blinding is not claimed. The 7-day oral overlap in the inhaled arm means the comparison is not inhaled-only versus oral-only from day one.

Verschoor-Kirss M, Rozanski EA, Sharp CR, Oura TJ, Egan A, Bain P, Knoll J. Treatment of naturally occurring asthma with inhaled fluticasone or oral prednisolone: A randomized pilot trial. Canadian journal of veterinary research = Revue canadienne de recherche veterinaire. 2021;85(1):61-67. PMID: 33390654. Registry ID: none in the record. MeSH: Animals · Cats · Female · Male · Administration, Inhalation · Administration, Oral · Asthma/drug therapy,veterinary · Cat Diseases/drug therapy · Fluticasone/administration & dosage,therapeutic use · Pilot Projects · Prednisolone/administration & dosage,therapeutic use

Leemans 2012: in an experimental acute asthma model, inhaled fluticasone ± salmeterol inhibited airway hyper-responsiveness like oral prednisolone

Prospective controlled therapeutic trial, randomised cross-over design (record's own wording; publication types include Randomized Controlled Trial)

Who: Cats: 6 experimental cats sensitised to Ascaris suum in a laboratory asthma-model setting, undergoing four aerosol allergen challenges at 1-month intervals, each followed by four consecutive days of one treatment in randomised cross-over order: oral prednisolone 1 mg/kg twice daily, inhaled fluticasone propionate 500 µg twice daily, or inhaled fluticasone/salmeterol 500 µg/50 µg twice daily; lung function, airway responsiveness and bronchoalveolar lavage fluid (BALF) cytology assessed, with barometric whole-body plethysmography.

Result: No significant differences in respiratory rate or Penh (an estimate of airflow limitation) were detected among treatment groups. Allergen-induced airway hyper-responsiveness was significantly inhibited by all three steroid treatments (P <0.05). The mean BALF eosinophil percentage was lower after oral and inhaled corticosteroid treatment, and these changes were significant for the groups receiving prednisolone and the fluticasone/salmeterol combination.

Watch out: Experimental acute asthma model in 6 sensitised cats — not client-owned cats with chronic natural asthma, and treatment lasted only four days per challenge. The record does not state blinding of assessors, and none is claimed. The significant BALF eosinophil result attaches to prednisolone and to the combination, not to fluticasone alone as worded in the abstract.

Leemans J, Kirschvink N, Clercx C, Snaps F, Gustin P. Effect of short-term oral and inhaled corticosteroids on airway inflammation and responsiveness in a feline acute asthma model. Veterinary journal (London, England : 1997). 2012;192(1):41-8. PMID: 21354836. Registry ID: none in the record. MeSH: Administration, Inhalation · Administration, Oral · Albuterol/administration & dosage,analogs & derivatives · Allergens/adverse effects · Androstadienes/administration & dosage · Animals · Anti-Inflammatory Agents/administration & dosage · Antigens, Helminth/adverse effects · Ascaris suum/immunology · Asthma/drug therapy,immunology,veterinary · Bronchodilator Agents/administration & dosage · Cat Diseases/drug therapy,immunology · Cats · Cross-Over Studies · Drug Combinations · Female · Fluticasone · Fluticasone-Salmeterol Drug Combination · Male · Prednisolone/administration & dosage · Prospective Studies

Cohn 2010: inhaled fluticasone 44, 110 or 220 µg twice daily cut airway eosinophilia by 74%, 82% and 81% in experimental feline asthma, with no adrenal suppression

Blinded, randomized, cross-over study (record's own wording)

Who: Cats: experimental cats with experimentally induced allergic airway inflammation in a laboratory setting (specific pathogen-free organisms per the record's MeSH), given fluticasone propionate by metered dose inhaler at 44, 110 or 220 µg every 12 hours in a blinded, randomized, cross-over design; airway eosinophilia and hypothalamic-pituitary-adrenal axis (HPAA) suppression assessed at each dose.

Result: Fluticasone administered at dosages of 44, 110, or 220 µg every 12 hours reduced airway eosinophilia by 74%, 82%, or 81%, respectively, with no difference between doses. None of the dose regimens tested caused HPAA suppression. The authors concluded that a twice-daily dosage of 44 µg fluticasone should be evaluated for the management of cats with naturally occurring inflammatory bronchial disease.

Watch out: This is the genuine Cohn et al. 2010 record behind the draft anchor — an experimental asthma-model dose study with no oral prednisolone arm, so it supports inhaled efficacy and dose, not the inhaled-versus-oral comparison directly. Experimentally induced disease in laboratory cats; transport to client-owned chronic asthma is an extrapolation the authors themselves frame as needing evaluation.

Cohn LA, DeClue AE, Cohen RL, Reinero CR. Effects of fluticasone propionate dosage in an experimental model of feline asthma. Journal of feline medicine and surgery. 2010;12(2):91-6. PMID: 19647461. Registry ID: none in the record. MeSH: Administration, Inhalation · Androstadienes/therapeutic use · Animals · Anti-Asthmatic Agents/therapeutic use · Asthma/drug therapy,veterinary · Bronchodilator Agents/therapeutic use · Cat Diseases/drug therapy · Cats · Dose-Response Relationship, Drug · Female · Fluticasone · Hypothalamo-Hypophyseal System/drug effects · Male · Metered Dose Inhalers/veterinary · Pituitary-Adrenal System/drug effects · Random Allocation · Specific Pathogen-Free Organisms · Treatment Outcome

Chang 2013: with rush immunotherapy, airway eosinophilia was suppressed at month 6 in oral, inhaled and placebo groups alike (P = 0.291) in experimental feline asthma

Randomized study (record's own wording: cats randomized to treatment groups; publication types include Randomized Controlled Trial)

Who: Cats: experimental cats sensitized using Bermuda grass allergen in a laboratory asthma-model setting (n = 6 per group), randomized to receive Bermuda grass-specific rush immunotherapy (RIT) for 9 months with, for the first 6 months, an oral glucocorticoid (prednisolone 10 mg daily), an inhaled glucocorticoid (fluticasone 220 µg twice daily), or placebo; bronchoalveolar lavage fluid (BALF) percent eosinophils and other immunological assays performed.

Result: Eosinophilic airway inflammation was suppressed in all groups at month 6 of RIT (group mean ± SD BALF percent eosinophils 5 ± 2% for oral glucocorticoid, 13 ± 4% for inhaled glucocorticoid, and 7 ± 2% for placebo; P = 0.291). BALF percent eosinophils increased significantly over time only in the oral glucocorticoid/RIT cats between months 6 and 9 (P = 0.031). No significant differences were found between groups at month 6 or over time for BGA-specific lymphocyte blastogenesis, percent blood T regulatory cells, or number of IL-10-producing cells.

Watch out: Every group received immunotherapy, so this card speaks to the glucocorticoid comparison only as an adjunct-to-RIT question in an experimental model — the placebo/RIT group suppressed eosinophilia as much as either steroid group at month 6. The record does not state blinding, and none is claimed. Included because it is a genuine randomised oral-versus-inhaled glucocorticoid comparison in feline asthma-model cats; it should not be read as a stand-alone treatment trial.

Chang CH, Cohn LA, Declue AE, Liu H, Reinero CR. Oral glucocorticoids diminish the efficacy of allergen-specific immunotherapy in experimental feline asthma. Veterinary journal (London, England : 1997). 2013;197(2):268-72. PMID: 23434218. Registry ID: none in the record. MeSH: Administration, Oral · Allergens/immunology · Animals · Asthma/chemically induced,drug therapy · Bronchoalveolar Lavage Fluid/chemistry · Cat Diseases/chemically induced,drug therapy · Cats · Cynodon/immunology · Desensitization, Immunologic/veterinary · Female · Gene Expression Regulation/drug effects · Glucocorticoids/administration & dosage,pharmacology · Immunoglobulin E · Interleukin-5/chemistry,genetics,metabolism · Lymphocyte Activation · Lymphocytes · Male

Synthesis: inhaled fluticasone controls airway eosinophilia comparably to oral prednisolone in the evidence available — but the natural-disease evidence is one 9-cat pilot

Synthesis

Who: Synthesis of the cards above: Verschoor-Kirss 2021 (9 client-owned cats with naturally occurring asthma, randomised pilot), Leemans 2012 (6 experimental Ascaris suum-sensitised cats, randomised cross-over), Cohn 2010 (experimental allergic airway inflammation, blinded randomized cross-over dose study) and Chang 2013 (experimental Bermuda grass model, randomised, n = 6 per group, immunotherapy background).

Result: Across settings: (1) clinical signs resolved and airway eosinophilia improved on both routes in the natural-disease pilot, with no radiographic improvement on either; (2) airway hyper-responsiveness was inhibited by inhaled and oral steroids alike in the acute model; (3) inhaled fluticasone's anti-eosinophilic effect showed no dose gradient between 44 and 220 µg twice daily and no HPAA suppression at any tested dose in the experimental model. Nothing carded shows oral prednisolone superior for airway inflammation; nothing carded is large enough to prove the routes equal in client-owned cats.

Watch out: Three of four carded studies are experimental asthma models in laboratory cats, not client-owned cats with chronic bronchial disease — the population named in this shelf's question is directly represented only by the 9-cat pilot. Draft anchor correction: 'Venema et al. 2010' (PMID: 20800209) is a review article, not a comparative trial, and is deliberately not carded.

Synthesis of Verschoor-Kirss M et al. PMID: 33390654; Leemans J et al. PMID: 21354836; Cohn LA et al. PMID: 19647461; Chang CH et al. PMID: 23434218. Registry IDs as on the individual cards.

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