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Nebulizing: Helping bunnies breathe easier

Nebulizing treatments are recommended by some of the top rabbit veterinarians in the
U.S.A as a treatment for respiratory infections, both upper (nasal congestion, sneezing) and lower (bronchitis, pneumonia). A nebulizer dispenses medication as a fine spray or
mist which can be inhaled by your rabbit, delivering medicine more directly to the site
of the infection (nose, sinuses, bronchial passages, lungs).

Nebulizing treatments are typically used in conjunction with systemic antibiotic therapy, sometimes with the same antibiotic but more often with a complementary one. Nebulizing treatments are usually given once or twice a day for 15-20 minutes at a time, sometimes for several weeks. Gentamicin is one antiobiotic that is commonly used in a nebulizer. While gentamicin injections are normally given only for a few days because of the potential for kidney damage, gentamicin can be used safely for several weeks in a nebulizer. Your rabbit's fur collects the moisture from the mist, minimizing the amount that is absorbed through the skin. And since gentamicin is not absorbed well when given orally, there is little danger from the small amount that might be ingested by grooming after a treatment.

Some veterinarians prefer to give these treatments in their office. However treatments can easily be done it at home. While the initial cost of equipment is high, it quickly pays for itself considering the cost of a single vet appointment.

Before giving a nebulizing treatment at home, you will need the following:

• A nebulizer
• Medications prescribed by your veterinarian
• A "nebulizing chamber" or mask to ensure your rabbit inhales enough medication
  

A nebulizer is a piece of medical equipment that consists of an air compressor, a hose to transport the air, and a compartment that holds the medication. There are many types of nebulizers available.

Your veterinarian will decide what medication(s) should be used in your nebulizer. Most nebulizer recipes include an antibiotic. Whenever possible, your veterinarian should do a culture/sensitivity test to determine what antibiotics will work best for your rabbit's condition.

Many veterinarians use a nebulizer recipe consisting of a precise amount of each of the following ingredients:

• Saline
• An antibiotic (most often gentamicin, but amikacin, and injectable forms of other antibiotics, including Baytril®, have also been used)
• A bronchiodilator such as aminophylline
• A medication that loosens mucus in the airways such as Mucomyst®
  (Acetylcysteine)

If multiple ingredients are used, be sure you carefully follow the recipe to ensure that proportions are correct. Based on your rabbit's other medical conditions, your veterinarian may decide to use a completely different set of medications than those listed above or to not use certain ingredients. In most cases of bronchitis or pneumonia,
Mucomyst and aminophylline are normally used together when nebulizing rabbits. Rabbits can be nebulized either using a mask or by placing them in a "nebulizing chamber." Your veterinarian may prefer one approach over the other - or your rabbit's personality may make one method considerably less stressful than the other.

A nebulizing chamber can be any enclosure that is relatively airtight (so the air in the "chamber" quickly becomes saturated and your rabbit is forced to breathe the medication), but still allows enough air in so he does not suffocate.

Some veterinarians feel your rabbit will get more medication in his system if he is "masked" during the treatment. Your veterinarian can order a mask like the ones s/he uses for anesthesia Or some people have improvised with a kitchen funnel or the top half of a plastic pop bottle with the rough edges protected with vet wrap. If you do improvise, be sure the pop bottle is thoroughly washed and that all rough edges are adequately covered! It is important to thoroughly clean both the hose and the nebulizing chamber or mask (to prevent cross-contamination) if equipment is being used on more than one rabbit. If you borrow or rent the nebulizer, play it safe and don't assume the person who used it last cleaned it! You can clean the hose by soaking it in a 10% bleach solution. Rinse thoroughly after cleaning and allow it to dry. Use an antibacterial soap to clean the nebulizing chamber or mask - or consider having a separate one for each rabbit.

Nebulizing Murray

In the fall of 2002, Murray developed an upper respiratory infection. The primary
symptom was severe sneezing fits with little discharge. Dr. Allan did a deep nasal culture
and started him on trimethoprim sulfa. The culture/sensitivity came back pseudomonas
sensitive only to Baytril, amikacin, and gentamicin - the same bacteria that has plagued his ears for the last four years. Because of his heart condition and the other medications he is on, we decided to start with Baytril rather than amikacin. When there was little improvement after a week, I asked Dr. Allan if we should also consider nebulizing and she agreed. We considered substituting amikacin for gentamicin in the "standard recipe," until Dr. Allan found references in the Veterinary Drug Handbook stating that amikacin might be incompatible with aminophylline. Originally I gave Murray his treatments in the nebulizing chamber.

We decided to give treatments only once a day because the confining box was stressful for him, even though I sat next to him throughout the entire treatment. After two weeks of nebulizing combined with systemic treatment with Baytril, Murray stopped sneezing and we discontinued all medication.

Unfortunately, within a week of discontinuing medications the sneezing had returned. We restarted both the Baytril and the nebulizing treatments. This time Murray made it clear he did not like the nebulizing chamber - despite the fact that there was barely room to do so, he managed to turn around in the chamber so his butt was receiving the medication instead of his nose! We agreed that a mask would work better. Dr. Allan ordered one for me, and while we waited for it I continued the treatments without mask or chamber, holding the nebulizer's mouthpiece under his nose so he would breathe the medication.

It is difficult to say how much the nebulizing treatments helped Murray, although I do believe they contributed to his recovery. Ultimately, we ended up treating the infection with amikacin, the only antibiotic that has ever seemed to work against Murray's pseudomonas. Symptoms improved dramatically after only a few days of treatment with
amikacin injections.

Kathy Smith

Nebulizing Ginger

At first we thought Ginger had a molar spur - he had a runny eye and wasn't eating well. He later began to sneeze. A vet appointment confirmed a molar spur, but testing showed that he also had a pasteurella infection. We tried various medications, injectable penicillin as well as oral medication (a sulfa drug and ciprofloxacin). There was some success, but we weren't kicking the "bug".

I had read great things about nebulizing to treat respiratory infections that don't respond to oral medications and wanted to try it. My vet had never tried nebulizing a mammal before but prescribed gentamicin and saline for us to use. When we began nebulizing Ginger, we did it twice a day for fifteen minutes, which is how long it takes for 1 cc of
gentamicin, mixed with 5 cc of saline to work through the compressor.

We put Ginger in a small animal carry case, with the holes on the sides and front of the case taped up to help keep the vapor inside. We put the gentamicin/saline solution in a small container (inside the case), which is attached to the compressor by a tube.
We enticed Ginger into the case with a carrot and some pellets, so he was occupied for 15 minutes. We closed the door and turned on the machine.

At first he didn't seem to like being in the carry case much at all. After the carrot was finished we would hear the case rattle and shake as he butted the door with his nose. When he came out, he would toss things out off the counter. These days Ginger is a little more relaxed. Now when we unlock the carry case door, a strong but controlled nose
butt sends the carry case door flying open to reveal Ginger's head poking from a cloud of vapor, looking for all the world like a rock star making a grand entrance through a cloud of dry ice! Not too long ago, after an afternoon session, he fell asleep in the carry case and had to be picked up from inside the case to be put back in his run space, so I guess he's getting used to it.

We noticed an improvement with Ginger's condition after two and a half weeks of using the nebulizer. We have yet to determine whether Ginger just has a molar spur that bugs him every fivemonths or so, or if he still has pasteurella or even a mild root problem that causes him some discomfort once in a while. Now we only nebulize him as needed.

We were lucky enough to get our nebulizer from a couple whose baby had asthma, but no longer needed to be given medication this way. If I were looking for another one, I would look around for a good used one. The tubing is disposable and can be purchased
from a medical supply store and it's easy to ensure that the permanent parts are clean with rubbing alcohol before use.

The optimum size vapor droplet for nebulizing is about 1 to 3 microns. At this size, the bubble or particle has a better chance of penetrating the membrane wall and delivering the medication straight to its target. Utrasonic nebulizers at the top dollar range deliver about 90% of droplets at this ideal range size. Jet nebulizers, which are a little more economical, produce about 55% in this range.

Shannon Clark/John Pitts

Where to obtain the equipment

Purchasing a new nebulizer will cost approximately $200.00. Some medical supply companies such as Medigas and VitalAire will rent nebulizers for $25.00-30.00 per month and have retail locations throughout the province. No prescription is required to purchase or rent a nebulizer.

Companies such as Avida Healthwear and Global Drugs sell masks, kits and other nebulizing accessories on-line.

Visit http://www.showcatsonline.com/ build_nebulizer.html (members only) to learn how to build a home-made nebulizing chamber.

When looking for used equipment start by talking to health care professionals. However, if you need to start using a nebulizer immediately you may not have to time locate a used unit. If you would like more information about nebulizing please contact us.

Special thanks to Kathy Smith, Dr. Allan.