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How to nebulize and coupage a dog with aspiration pneumonia | VETgirl Veterinary Continuing Education Blog

In this VETgirl online veterinary continuing education blog, we demonstrate how to nebulize and coupage a dog with aspiration pneumonia to hydrate the lower airway and mobilize secretions. This is a 7-month-old, male intact Bulldog that presented for tachypnea and dyspnea for a one week duration after vomiting. Chest radiographs revealed bronchopneumonia, with alveolar consolidation of the right cranial lung lobe and a diffuse bronchial pattern. The prognosis for aspiration pneumonia, with treatment, is fair to good, but requires aggressive therapy. Treatment includes hydration, appropriate antibiotic therapy, oxygen therapy, measurement of hypoxemia, and nebulization and coupage. The goal of nebulization is to hydrate the lower airway (specifically the ciliary escalator) with small droplets of water which are inhaled into the respiratory tract.

Before purchasing a nebulizer, one should identify the type (e.g., ultrasonic nebulizer, etc.) and confirm what sized water droplets are created. The larger the droplet, the more likely it will be trapped within the upper airway. The smaller the droplet, the more likely it will penetrate deeper within the lower airway, allowing appropriate hydration. Droplets greater than 10 microns typically stay within the upper airway and trachea, while droplets in the range of 1-10 microns are able to penetrate into the lower respiratory tract. Again, the smaller the droplet, the deeper it can go. Droplets less than 0.5 microns can reach the alveolar level and are exhaled. Most ultrasonic nebulizers create water droplets ranging in the 2-5 micron size. Following nebulization, aggressive, firm coupage should then follow to help stimulate productive coughing and thus, mobilize secretions and allow the purulent material to be expectorated out. Thankfully, this puppy recovered well and was discharged within 24 hours.

References:
1. 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.
2. 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(11):1748-1755.
3. Kogan DA, Johnson LR, Jandrey KE, et al. Clinical, clinicopathologic, and radiographic findings in dogs with aspiration pneumonia: 88 cases (2004-2006). J Am Vet Med Assoc 2008;233(11):1742-1747.
4. King L. Treating canine bacterial pneumonia: Beyond antibiotics. CVC Kansas City Proceedings, 2009.

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