Quality ofLife

Respiratory distress and coughing are the two main signs that affect patient quality of life (QOL) in animals with tracheal collapse. Persistent coughing is likely to cause tracheal pain or discomfort in addition to the irrita­tion.

Airway obstruction is an extremely dis­tressing experience and with time becomes progressively more frequent and severe, eventually resulting in hypoxic syncope episodes, which may be fatal. Between obstructive episodes patient QOL may be reasonable; however, obstructive episodes may be episodic and unpredictable. In early stages, obstruction may be mild, such that patient distress is minimal and short lived. At this point treatment options not yet addressed, or poorly implemented, must be explored and optimized. Once respiratory distress is severe and cannot be controlled (due to financial reasons or otherwise) end of life should be discussed with the caregiver.

Many caregivers experience helplessness when they are unable to provide relief to their pets' coughing attacks or respiratory distress. Alternatively, clients may be willing, but unable to provide treatment for various reasons, such as cost. Intraluminal tracheal stents cost in the excess of $1000, excluding placement, and caregivers may feel guilt at not being able to afford treatment. The unpredictable nature of coughing or airway obstruction can elevate the anxiety of the caregiver. Some caregivers will request euthanasia due to intractable coughing.

Euthanasia should be advised whenever respiratory distress cannot be controlled or relieved by the combination of supportive, medical and surgical treatment options. When airway obstruction is severe, pro­longed or frequent; quality of life is poor and should prompt euthanasia.