Spontaneous pulmonary alveolar proteinosis in captive "moustached tamarins" (Saguinus mystax)

Pulmonary alveolar proteinosis is a rare human disease characterized by accumulation of surfactant in alveoli without generating an inflammatory response. Lung lesions resembling pulmonary alveolar proteinosis were observed in 7 adult tamarins (5 males and 2 females). Gross lesions were characterized by areas of discoloration, slight bulging over the lung parenchyma, and occasional consolidation. Histologic examination of tamarin lung samples revealed intra-alveolar accumulation of amorphous, amphophilic, periodic acid-Schiff-positive, finely granular to dense material. In some cases, type II pneumocyte hypertrophy and hyperplasia were observed with pleural and septal thickening and fibrosis. Large numbers of intra-alveolar foamy macrophages were noted surrounding and/or in the vicinity of the lesions. Immunohistochemical analysis of the lung lesions using polyclonal (surfactant proteins A, B, and C) and monoclonal (surfactant protein D) antibodies revealed the granular material to be composed largely of surfactant protein B, followed by surfactant protein A. Surfactant proteins C and D were present in lesser quantities, with the latter observed surrounding the lipoproteinaceous deposits. Transmission electron microscopy of the affected lungs showed numerous, irregularly shaped osmiophilic lamellar bodies in type II pneumocytes. The cytoplasm in alveolar macrophages was expanded, containing ingested surfactant with swollen mitochondria and rough endoplasmic reticulum. Thoracic radiographs, available in 1 animal, depicted the lesions as small multifocal opacities randomly distributed in cranial and diaphragmatic lung lobes. This is, to the authors' knowledge, the first report of spontaneous pulmonary alveolar proteinosis in nonhuman primates.     

Adult respiratory distress syndrome (ARDS). Incidence, clinical findings, pathomorphology and pathogenesis. A review

Acute and progressive respiratory distress ("shock lung") is a well known and feared complication in human patients with a variety of underlying disorders, even though the lungs are not involved primarily. In spite of the fact that dogs, and other animals, very often have been used in experimental models studying this syndrome, "shock lungs" have not received much attention in veterinary medicine. With the improved and more intensive treatment of severely diseased animals during the last years, especially pet animals, it is reasonable to assume that the lungs will be more important as an end organ also in veterinary practice. Animals in shock, particularly if complicated with sepsis, are prone to develop progressive respiratory distress. This paper reviews the current knowledge about the clinical picture, pathology and pathogenesis of acute respiratory disease, with main emphasize on the pathogenetic mechanism.     

Suggested Strategies for Ventilatory Management of Veterinary Patients with Acute Respiratory Distress Syndrome

Objective: To review the current recommendations and guidelines for mechanical ventilation in humans and in animals with acute respiratory distress syndrome.
Human data synthesis: Acute respiratory distress syndrome (ARDS) in humans in defined as an acute onset of bilateral, diffuse infiltrates on thoracic radiographs that are not the result of heart disease and a significant oxygenation impairment. These patients require mechanical ventilation. Research has shown that further pulmonary damage can occur as a result of mechanical ventilation. Various alveolar recruitment maneuvers and a low tidal volume with increased positive end expiratory pressure (PEEP) have been associated with an increased survival.
Veterinary dat synthesis: Two veterinary reports have characterized ARDS in dogs using human criteria. There are no prospective veterinary studies using recruitment that ventilator-induced lung injury (VILI) occurs in dogs, sheep, and rats.
Conclusion: Recruitment maneuvers in conjunction with low tidal volumes and PEEP keep the alveoli open for gas exchange and decrease VILI. Prospective veterinary research in needed to determine if these maneuvers and recommendation can be applied to veterinary patients.     

Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: The Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine

Background: As veterinary medicine has become more sophisticated, with greater numbers of veterinary patients receiving intensive care, more patients with an acute respiratory distress (ARDS)‐like syndrome have been recognized. Methods: A consensus definition meeting was held for the purpose of developing veterinary‐specific definitions for acute lung injury (ALI) and ARDS. Results/conclusions: Three clinically based definitions for acute lung injury and acute respiratory distress‐like syndromes occurring in veterinary patients were described. Neonatal equine respiratory distress syndrome (NERDS) was defined separately due to the specific requirement for primary developmental surfactant dysfunction and lack of an inflammatory component. Five diagnostic criteria categories were established for Veterinary ALI/ARDS (Vet ALI/ARDS) with 4 required and a fifth highly recommended criteria. A strong consensus was reached that onset of respiratory distress must have been acute and that known risk factors must be present. Additional criteria included evidence of pulmonary capillary leak with no evidence of increased pulmonary capillary pressure, evidence of inefficient gas exchange and, finally, evidence of inflammation. Some features of ALI/ARDS in the neonatal horse were recognized as unique, therefore, equine neonatal ALI/ARDS (EqNALI/EqNARDS) was similarly defined but with a graded gas exchange inefficiency table to allow for normal developmental changes in gas exchange. Use of these definitions in planning prospective studies of these problems in veterinary patients should allow for more direct comparisons of studies and clinical trials, with a larger goal of improving outcome in veterinary patients.     

Treatment of premature calves with clinically diagnosed respiratory distress syndrome

BACKGROUND: Respiratory distress syndrome (RDS) has been reported previously in premature calves. However, there have been no published data on the effect of surfactant replacement therapy in the treatment of premature calves with RDS. HYPOTHESIS: Surfactant replacement therapy added to the standard treatment for premature calves clinically diagnosed with RDS would increase the viability of the calves. ANIMALS: Twenty-seven premature calves with clinically diagnosed RDS. METHODS: Twenty calves were instilled intratracheally with bovine lung surfactant extract and provided with standard treatment for RDS (surfactant group). Seven calves were given only standard care for RDS without surfactant therapy and placed in the control group. Standard treatment for newborn calves with RDS includes warming, administration of intranasal oxygen, fluid replacement, administration of antibiotics, and immunoglobulin solution. Arterial blood samples were collected from the calves at 3 observation points, the first just before treatment (hour 0) and at 2 hours (hour 2) and 24 hours (hour 24) after treatment was started to determine if ventilation was adequate, improving, or deteriorating. Blood gases, pH, bicarbonate, and lactate concentrations were measured. RESULTS: In the surfactant group, mean partial pressure of oxygen significantly increased at hours 2 and 24. Mean partial pressure of carbon dioxide decreased and mean arterial blood pH increased at hour 24 in the surfactant group compared with the control group (P < .05). Of the 20 calves in the surfactant group, 12 survived and 8 died. All 7 calves in the control group died. CONCLUSIONS AND CLINICAL IMPORTANCE: The results of this study suggest that surfactant replacement therapy may reduce neonatal deaths in premature calves with clinically diagnosed RDS.     

Respiratory Distress Resulting from Acute Lung Injury in the Veterinary Patient

Because of improved management of animals in intensive care facilities, veterinarians are often confronted with patients at risk of developing adult respiratory distress syndrome (ARDS). The four objectives of this review are: 1) to describe the clinical conditions which place animals at risk for development of ARDS, 2) to give the reader a comprehensive understanding of the pathophysiology of endotoxin-induced lung injury, 3) to address the interspecies variability in susceptibility to endotoxin-induced lung injury, and 4) to outline areas where veterinarians should be concentrating their diagnostic and therapeutic efforts with regards to this syndrome. Because there is little written in the veterinary literature on ARDS, this review will rely heavily on the human ARDS literature as well as on research in animal models of acute lung injury.     

Light and electron-microscopic localization of CD9 and surfactant protein A and D in normal lungs of the horse

The lung is a complex organ, and its physiology and immunology are regulated by various immune molecules and cells. Lung surfactant, a mixture of phospholipids and proteins produced by the bronchiolar and type II alveolar epithelial cells, is one such important player in lung physiology. Compared to knowledge about the biology of the surfactant in rodents and humans, only limited data are available on the surfactant in the horse. Although there are data linking levels of surfactant proteins with respiratory disease in the horse, there are no data on the cellular localization of surfactant protein A (SP-A) and surfactant protein D (SP-D). A member of the tetraspanin family of proteins, CD9 is a cell-signaling and adhesion protein and its expression has been detected in both normal and cancer cells, including those in the lung. Because there are no immunolocalization data on SP-A, SP-D, and CD9 in the normal lungs of the horse, our objective was to conduct a light and electron microscopic immunocytochemical study on normal lungs of the horse. The data showed SP-A and SP-D in bronchiolar epithelial and type II alveolar epithelial cells. These proteins were also localized in type I alveolar epithelial cells, pulmonary intravascular macrophages, and neutrophils, which is likely an outcome of endocytosis of the proteins by these cells. CD9 was present in the airway and vascular smooth muscle cells, endothelium, and blood cells, but not in the airway epithelium. These new data provide a baseline to further examine the expression and functions of SP-A, SP-D, and CD9 proteins in inflammation associated with respiratory diseases in the horse.     

Neonatal respiratory distress syndrome in the calf

Thirty-five calves were delivered by caesarean section near to term. During the operation amniotic fluid was collected for determination of the lecithin/sphingomyelin (L/S) ratio. Clinical examination of the calves and analysis of blood gas concentration (venous blood) were carried out within the first hour of life. Fifteen out of 35 calves under examination did not show clinical or blood gas disorders in the course of the first hour of life. In these calves, the L/S ratio, which represents a measure for the maturity of the surfactant system, averaged 2.6. The other 20 calves, however, developed a respiratory distress syndrome together with a progressive respiratory and metabolic acidosis within the first hour of life. The L/S ratio in the animals affected with respiratory distress syndrome reached an average value of 1.5 which was significantly below that of the calves not suffering from respiratory distress. Eleven of the 20 calves which developed respiratory distress syndrome died within the first 60 hours of life. The most striking findings in the post mortem examinations of these animals were intracranial haemorrhages and pulmonary lesions (hyaline membranes, interstitial and alveolar oedema). On the basis of the significantly lower L/S ratio and the post mortem findings, it is to be assumed that the respiratory distress syndrome in calves, equally with that in infants, is attributable to a surfactant deficiency.     

Lung surfactant function and composition in neonatal foals and adult horses

BACKGROUND: Lung surfactant function and composition are varied and adapted to the specific respiratory physiology of all mammalian species. HYPOTHESIS: Lung surfactant function and composition are different in neonatal foals as compared to adult horses. ANIMALS: Six adult horses, 7 term foals (<24 hours old), and 4 premature foals were used. Animals were part of the Auburn University teaching herd except for 3 client-owned premature foals. METHODS: Bronchoalveolar lavage fluid (BALF) was obtained from all animals. Ultracentrifugation of cell-free BALF separated surfactant into crude surfactant pellets (CSP) and supernatant. Both fractions were analyzed for phospholipid and protein content with the Bartlett and bicinchoninic acid method, respectively. Phospholipid composition of the CSP was determined by using high-performance liquid chromatography with an evaporative light scatter detector. Surface tension of the CSP was measured with a pulsating bubble surfactometer. Results from term foals (<24 hours old) were compared statistically to those from adult horses. Values of P < .05 were considered significant. RESULTS: BALF phospholipid content was similar between adult horses and term foals, but BALF protein content was significantly decreased in term foals. Phosphatidylglycerol was significantly decreased, phosphatidylinositol was significantly increased, and the minimum surface tension was significantly increased in the CSP from term foals compared to adult horses. CONCLUSIONS AND CLINICAL IMPORTANCE: Surface tension and phospholipid composition of surfactant in neonatal foals are significantly different compared to adult horses. These changes may influence biophysical and immunologic functions of surfactant.     

Acute respiratory distress syndrome in dogs and cats: a review of clinical findings and pathophysiology

Objective: To review the clinical and pathophysiologic aspects of acute respiratory distress syndrome (ARDS) in dogs and cats. Data sources: Data from human and veterinary literature were reviewed through Medline and CAB as well as manual search of references listed in articles pertaining to acute lung injury (ALI)/ARDS. Human data synthesis: Since the term ARDS was first coined in 1967, there has been a abundance of literature pertaining to this devastating syndrome in human medicine. More complete understanding of the complex interactions between inflammatory cells, soluble mediators (e.g., tumor necrosis factor, interleukin (IL)‐6, IL‐8, platelet activating factor) and the clinical patient has provided for timely recognition and mechanistically based protective strategies decreasing morbidity and mortality in human patients with ARDS. Veterinary data synthesis: Although little is known, ARDS is becoming a more commonly recognized sequela in small animals. Initial case reports and retrospective studies have provided basic clinical characterization of ARDS in dogs and cats. Additionally, information from experimental models has expanded our understanding of the inflammatory mechanisms involved. It appears that the inflammatory processes and pathologic changes associated with ARDS are similar in dogs, cats, and humans. Conclusions: Unfortunately, current mortality rates for ARDS in small animals are close to 100%. As our capability to treat patients with advanced life‐threatening disease increases, it is vital that we develop a familiarity with the pathogenesis of ARDS. Understanding the complex inflammatory interactions is essential for determining effective preventative and management strategies as well as designing novel therapies for veterinary patients.     

Application of Airway Pressure Therapy in Veterinary Critical Care: Part II: Airway Pressure Therapy

As the specialties of emergency medicine and critical care have grown and evolved in both human and veterinary medicine, so has the need for more advanced care of patients with primary lung disease. Treatment of acute respiratory failure has been the focus of several articles in the human medical literature of the past few years.^1,8 This paper deals with airway pressure therapy and its application in cases of acute respiratory failure in veterinary medicine. The reader is referred to part I of this paper for a reveiw of respiratory mechanics and hypoxemia as they apply to respiratory therapy.     

Discussion of the Compendium of Veterinary Standard Precautions: preventing zoonotic disease transmission in veterinary personnel

Veterinary practices are unique environments that bring humans into close contact with many different species of animals; therefore, the risk of exposure to infectious pathogens is inherently different in veterinary medicine than in human medicine. In contrast to the risk of exposure to blood in human medicine, infections from zoonotic diseases in veterinary personnel are primarily related to exposure to animal faeces, infected skin, wounds, droplets and puncture wounds. Infection-control measures in veterinary practices are often insufficient to prevent zoonotic disease transmission. The Veterinary Standard Precautions (VSP) Compendium is designed to help prevent transmission of zoonotic pathogens from animal patients to veterinary personnel in private practice.     

Identification and characterization of an idiopathic pulmonary fibrosis-like condition in cats

Interstitial lung diseases are a heterogeneous group of disorders with a variety of causes. In veterinary medicine, such lung diseases with a prominent fibrotic component of unknown etiology are often called idiopathic pulmonary fibrosis (IPF). In human medicine, this term is reserved for a distinct disease entity with specific histologic findings labeled as usual interstitial pneumonia (UIP). We identified 23 cats displaying histologic criteria of UIP The purpose of this retrospective study is to describe the presentation and response to therapy of these cats to better define this disease entity. All but 2 cats were middle aged to older (median 8.7 years), with no apparent sex or breed predisposition. Complaints included respiratory distress (n = 18) and cough (13). Duration of signs was less than 6 months in 17 cats. Physical-examination abnormalities included tachypnea, inspiratory or mixed inspiratory and expiratory effort, and adventitial lung sounds. No consistent hematologic or biochemical abnormalities, parasites, or positive serologic results for feline retroviruses, heartworms, or toxoplasmosis were present. Radiographic changes included dense patchy or diffuse interstitial, bronchiolar, and alveolar infiltrates. Analysis of bronchial lavage fluid revealed mild neutrophilic inflammation (n = 6) with no consistent pathogen growth. Clinical condition of 5 cats worsened after lavage. Coincident pulmonary neoplasia was identified in 6 cats. Response to therapy (corticosteroids, antibiotics, bronchodilators, and diuretics) was poor, and most cats died within days to months. Cats with histologic changes compatible with UIP had signs that mimicked many of the clinical findings of human IPF, and treatment response was similarly unrewarding.     

Ethical issues in geriatric feline medicine

Most veterinarians hold a 'pediatric' rather than 'garage mechanic' view of their function. In recent years, sophisticated medical modalities have allowed veterinarians to keep animals alive, and increased value of companion animals in society has increased demand for such treatment. But whereas humans can choose to trade current suffering for extended life, animals seem to lack the cognitive apparatus required to do so. Thus, veterinarians must guard against keeping a suffering animal alive for too long. Clients may be emotionally tied to the animal and blind to its suffering. Part of the veterinarian's role, therefore, is to lead the client to 'recollect' quality of life issues. A second major role for the veterinarian in treating geriatric or chronically ill animals is control of pain and distress. Unfortunately, pain and distress have historically been neglected in both human and veterinary medicine for ideological reasons. It is ethically necessary to transcend this ideology which leads to both bad medicine and bad ethics.     

From horse doctor to cow leech to veterinary manager. Regulation of the market for veterinary services in historical perspective

In the course of the last two centuries veterinarians succeeded in gaining a monopoly with respect to a number of specific tasks within society under the motto "to the benefit of man and animal alike". Today, a veterinary infrastructure exists in the western world, which is usually taken for granted by society. Before the responsibility for maintaining animal resources and protecting both animal and human health were entrusted to veterinarians, both the process of scientific progress and professionalization of veterinary medicine were necessary. In this paper the regulation of the market for veterinary services in The Netherlands is decribed. Until World War II, the military and the colonies represented a major demand for veterinary services. A healthly livestock has always been considered as a main concern by the Dutch government with respect to the domestic food supply as well as exports. State intervention concerning veterinary medicine therefore focused on the organized campaigns against livestock diseases. Early national veterinary legislation originated from this concern, as is still the case today within the EU framework. The protection of human health only became part of the veterinary professional domain at a relatively late stage. Due to a strong economic growth from the 1960s onwards, veterinary practice was extended with the care for an increasing number of companion animals. The veterinary profession and its employment are subject to changes in society, such as the number of animals and the significance that is paid to the different species. In 1900 there were 4 million production animals in The Netherlands, while the human population counted 5 million. One century later, not less than approximately 130 million farm animals and 30 million companion animals are living in this country, which now has about 16 million inhabitants. Consquently, the total number of active vets increased from about 250 to 4,000 in the same period, while the number of group and solo practices both increased.     

Application of Airway Pressure Therapy in Veterinary Critical Care: Part I: Respiratory Mechanics and Hypoxemia

Over the past several decades, recognition of acute respiratory failure as the cause of death in patients suffering from various clinical conditions has prompted aggressiv investigation into the area of respiratory physiology and supportive respiratory care. With the evolution of emergency medicine and critical care services in both human and veterinary medicine, many patients previously considered unsalvageable due to the severity of their underlying disease are now being resuscitated and successfully supported, creating a new population of critically ill patients. Where only a decade ago these patients would have succumbed to their underlying disease, they now survive long enough to manifest the complications of shock and tissue injury in the form of acute respiratory failure. Investigation into the pathophysiology and treatment of this acute respiratory distress syndrom (ARDS) has facilitated increased clinical application of respiratory theerapy and machanical ventilation.¹ The purpose of this paper is to provide a basic review of respiratory mechanics and the pathophysiology of hypoxemia as they relate to airway pressure therapy in veterinary patients and to review the use of airway pressure therapy in veterinary patients This paper is divided into two parts; part I reviews respiratory mechanics and hypoxemia as they apply to respiratory therapy, while part II deals specifically with airway pressure therapy andits use in clinical cases.     

Pathophysiologic study of 3-methylindole-induced pulmonary toxicosis in immature cattle

In 5 Friesian calves given 3-methylindole (3-MI) (100 mg/kg once a week for 8 weeks, except calf 4, given a 50 mg/kg dose on weeks 3 to 8), pulmonary function (PF) values and arterial blood gas tensions (PaO2 and PaCO2) were measured 24 hours after dosing was done and were correlated with clinical, biochemical, and pathologic changes. Three of the calves (No. 1, 2, and 3) showed acute respiratory distress syndrome 24 hours after the first 3-MI treatment, with a large increase in respiratory frequency, minute viscous work, and PaCO2 and a large decrease in tidal volume, dynamic lung compliance, and PaCO2. They died 36, 38, and 84 hours after dosing. Pulmonary function changes were compatible with the severe pulmonary edema and alveolar damage observed at necropsy. The 2 other calves, after they were given the 1st dose, showed only subacute respiratory distress syndrome with less severe changes in PF values recorded at 24 hours. Furthermore, they became progressively more tolerant to the 2nd, 3rd, and 4th weekly treatments, and showed base-line PF values after the 5th weekly treatment. Pathologic changes were not observed in lung biopsy material from these 2 animals at 2 and at 12 weeks after the 8th (or last) 3-MI treatment.     

Evaluation of respiratory parameters at presentation as clinical indicators of the respiratory localization in dogs and cats with respiratory distress

Objective ? To describe clinical respiratory parameters in cats and dogs with respiratory distress and identify associations between respiratory signs at presentation and localization of the disease with particular evaluation between the synchrony of abdominal and chest wall movements as a clinical indicators for pleural space disease. Design ? Prospective observational clinical study. Setting ? Emergency service in a university veterinary teaching hospital. Animals ? Cats and dogs with respiratory distress presented to the emergency service between April 2008 and July 2009. Interventions ? None. Measurements and Main Results ? The following parameters were systematically determined at time of admission: respiratory rate, heart rate, temperature, type of breathing, movement of the thoracic and abdominal wall during inspiration, presence of stridor, presence and type of dyspnea, and results of thoracic auscultation. Abdominal and chest wall movement was categorized as synchronous, asynchronous, or inverse. Diagnostic test results, diagnosis, and outcome were subsequently recorded. Based on the final diagnoses, animals were assigned to 1 or more of the following groups regarding the anatomical localization of the respiratory distress: upper airways, lower airways, lung parenchyma, pleural space, thoracic wall, nonrespiratory causes, and normal animals. One hundred and seventy‐six animals (103 cats and 73 dogs) were evaluated. Inspiratory dyspnea was associated with upper airway disease in dogs and expiratory dyspnea with lower airway disease in cats. Respiratory noises were significantly associated and highly sensitive and specific for upper airway disease. An asynchronous or inverse breathing pattern and decreased lung auscultation results were significantly associated with pleural space disease in both dogs and cats (P<0.001). The combination is highly sensitive (99%) but not very specific (45%). Fast and shallow breathing was not associated with pleural space disease. Increased or moist pulmonary auscultation findings were associated with parenchymal lung disease. Conclusions ? Cats and dogs with pleural space disease can be identified by an asynchronous or inverse breathing pattern in combination with decreased lung sounds on auscultation.     

Monocytic/macrophagic pneumonitis after intrabronchial deposition of vascular endothelial growth factor in neonatal lambs

Preterm and young neonates are prone to inadequate surfactant production and are susceptible to respiratory distress syndrome characterized by alveolar damage and hyaline-membrane formation. Glucocorticoid therapy is commonly used in preterm and young infants to enhance lung maturation and surfactant synthesis. Recently, vascular endothelial growth factor (VEGF) was suggested to be a novel therapeutic agent for lung maturation that lacked adverse effects in mice. The purpose of this study was to assess the safety of incremental concentration (0.0005, 0.005, and 0.05 mg/ml) and duration (16, 24, and 32 hours) of recombinant human VEGF after bronchoscopic instillation (10 ml) in neonatal lambs. High-dose VEGF caused locally extensive plum-red consolidation that was microscopically characterized by interstitial and alveolar infiltrates of cells that were morphologically and phenotypically (CD68+) consistent with monocytes/macrophages. T cells (CD3+) and B cells (CD79+) were located primarily in bronchus/bronchiole-associated lymphoid tissue and were not consistently altered by treatment with VEGF. The dose of VEGF had significant effects on both gross lesions (P < .0047) and microscopic monocyte/macrophage recruitment scores (P < .0001). Thus, the VEGF dose instilled into the lung greatly influenced cellular recruitment and lesion development. The post-dosing interval of VEGF in this study had minor impact (no statistical significance) on cellular recruitment. This study showed that airway deposition of VEGF in the neonatal lamb induces monocyte/macrophage recruitment to the lung and high doses can cause severe lesions. The cellular recruitment suggests further research is needed to define dosages that are efficacious in enhancing lung maturation while minimizing potential adverse effects.     

The application of exhaled breath gas and exhaled breath condensate analysis in the investigation of the lower respiratory tract in veterinary medicine: A review

The analysis of biomarkers in exhaled breath (EB) and exhaled breath condensate (EBC) may allow non-invasive and repeatable assessment of respiratory health and disease in mammals. Compared to human medicine, however, research data from EB and EBC analysis in veterinary medicine are limited and more patient variables influencing concentrations of EB/EBC analytes may be present. In addition, variations in methodologies between studies may influence results. A comparison of the approaches used in veterinary research by different groups may aid in the identification of potentially reliable and repeatable biomarkers suitable for further investigation. To date, changes in acid-base status and increased concentrations of inflammatory mediators have been the main findings in studies of pulmonary disease states in animals. Whilst these biomarkers are unlikely to represent specific and sensitive diagnostic parameters, they do have potential application in monitoring disease progression and treatment response.