Pulmonary Fibrosis in Old West Highland White Terriers Wayne R. Hause, DVM, DACVIM
Over the years, I have had numerous old Westies that are presented to me with a chronic cough and dyspnea. Many have a very long history of coughing, treatment for which has been unrewarding. On physical examination they have a normal heart, diffuse loud crackles in the lungs and a marked expiratory effort. Radiographs show diffuse interstitial infiltrates of the lungs and the only cardiac change is cor pulmonale. In the end stage, they are treated with bronchodilators, cough suppressants and sometimes in-home oxygen therapy. They die or are euthanized fairly soon because of very poor quality of life due to the symptoms. Several years ago a very observant client brought in middle aged Westie with the complaint of exercise intolerance. The only obvious sign to the client was the patient’s inability to keep up with her brother on walks. She was normal on physical exam and radiographs but the owner just knew that something was wrong. I performed a bronchoalveolar lavage and found moderate acute inflammation with no causative organism. My conclusion was that the dog had immune mediated pneumonitis and I speculate that this is the process that leads to the end-stage pulmonary fibrosis Westie. I treated this pet with inhaled bronchodilators and steroids and the symptoms resolved for a long time. Subsequent to this case, I have seen several others. The following is a case history of an ongoing case. “Tassie” was presented to me as a 13 year old female Westie with bradycardia. She tired on exercise but had no coughing. On physical examination, she had a slow but regular heartbeat with diffuse loud crackles and a moderate expiratory effort. Her bradycardia was an atropine responsive second degree AV block that was due to excessive vagal tone. Her BAL findings were acute inflammation of no apparent cause. My diagnosis was pneumonitis probably immune mediated. She has been on albuterol and fluticasone since the diagnosis was made and remains minimally symptomatic to this day. In any practice, this kind of disease is uncommon but, looks out for it since when diagnosed early rather than at an end stage many of these pets can live much longer and better lives.