Asthma Inhaler Toxicosis in Dogs

Albuterol is a bronchodilator that is commonly prescribed to treat asthma, in the form of an inhaler. Albuterol inhalers are very commonly prescribed to people, and sometimes to animals. Dogs with access to these inhalers are at an increased risk of toxicity.

Asthma inhaler toxicosis is a medical emergency, as exposure to high doses of albuterol can cause life-threatening cardiac arrhythmias (irregular heart rhythm).

If the condition is left untreated, affected animals can develop severe cardiac damage, worsening their prognosis.

Cold thermal burns can occur when the asthma canister is punctured, causing damage to the mouth and airway.

In rare cases, this can cause swelling of the airway, which can be life-threatening. Dogs with cold thermal burns may have oral pain, increased drooling and decreased appetite.

Dogs diagnosed with underlying cardiac conditions, hypertension, and those prescribed antidepressant medications are at higher risk of severe cardiac complications. Dogs known to chew on nonfood items with access to an inhaler are at an increased risk.

Asthma inhaler toxicosis is caused by the inhalation or ingestion of large doses of albuterol. Severe toxicosis usually follows unintentional ingestion of large doses of albuterol, generally as the result of chewing on an inhaler.

Most commonly, exposure is caused by the perforation of asthma inhalers. However, albuterol is available in various forms:

• Aerosolized powder or liquid
• Syrups
• Tablets
• Injectable

Symptoms of albuterol toxicosis generally occur within a half-hour to eight hours from ingestion.

If the ingestion or inhalation is witnessed, the diagnosis is self-evident.

Ingestion may occur without a witness, but it can leave evidence, such as signs of chewing on inhalers. A dog suspected of having ingested a albuterol generally undergoes the following diagnostics:

• Physical examination
• Complete blood count
• Blood pressure
• Electrocardiogram

Once diagnosed, treatment is mainly of a symptomatic and supportive nature. Dogs exposed to liquid, syrup, and aerosolized forms of albuterol do not respond to decontamination as the absorption rate is too fast. Treatment options include:

• IV fluid therapy
• Hospitalization and monitoring
• Medications to address arrhythmia such as propranolol or lidocaine
• Benzodiazepines: used to manage tremors

Once treated, the animal's health condition must be closely monitored to reduce the risk of cardiac symptoms and seizures worsening.

With prompt and proper treatment and subsequent monitoring, dogs suffering from asthma inhaler toxicosis generally carry a good prognosis. Animals that develop severe tachycardia carry a guarded to poor prognosis.

Albuterol toxicosis is preventable by ensuring no contact is made with asthma inhalers.

Strategies include:

• Keeping medications out of reach of pets
• Properly dosing animals that are being treated with albuterol

Albuterol is very commonly prescribed, so toxicity is a risk to dogs with unsupervised access to inhalers.

Severe toxicosis is more common in puppies which are more likely to chew novel items and can ingest a relatively larger dose.

• IV fluid therapy
• Antiarrhythmics
• Benzodiazepines