Noisy inspiration - older cat

Our cat is 15 years old, going on 16. No serious issues when he was younger. A year ago he started showing signs of arthritis and we have been giving him Meloxicam since (0.1mg - total, not per kg body weight) every 3-4 days in summer, and 2-3 in winter). Since this January he has been breathing noisily, snoring and snorting sounds, but wet (phlegmy?) sounding. Slight weeping from right eye. He has been to our vet twice already. When it first started there were sneezing fits, along with a small amount of green mucus from his right nostril (more of a snot bubble, when he was sleeping). Vet was a little concerned since it was unilateral, but decided to first treat with a 7-day course of Doxy. His breathing was normal, and the snot bubble disappeared. But both returned about a week after the last dose of Doxy. She decided to repeat the Doxy - for five days this time - along with some Lysine gel. Same result as before, breathing was normal and no snot bubble during the course and for about 9 days after last dose of Doxy. The snot bubble has now completely disappeared, it is only his breathing that is still noisy. Second visit to the vet we left him there so she could do a more thorough examination with him being sedated. She checked and ruled out oronasal fistula and polyps. X-rays all appeared normal, except for one that indicated no oxygen in the right nasal passage. But nothing to suggest a tumour. She also flushed his nasal passages and sinus, with nothing there to suggest anything alarming either (no flushed tissue, etc. that would necessitate a biopsy). A visual examination of his nostrils doesn't reveal much - as expected. Given his age, the biggest concern was how long it took him to fully recover from the sedation. She commented how long he took to wake up at the practice, and at home he was unsteady on his feet into the next afternoon. Because of this, we are not keen to consider a CT scan, MRI, or rhinoscopy. His meow is slightly altered, which made me think there was mucus involved. But the vet felt a mucolytic would not be of any benefit. And given his age, she is also reluctant to try any glucocorticoids. Because of the Petcam, we do have regular blood work done, and that is all normal. I have taken to giving him steam treatment - 10-15 minutes in the bathroom with the shower hot water running. Only started last Friday, but seems to help on some days. Is there anything else we can do to ensure he is comfortable? Should also add he is not lethargic, no change in his appetite or fluid intake (we've never had any hassles getting him to drink water), and no obvious signs of distress.

Hello - there are two schools of thought here.  The scientific, medical school of thought, that seeks to find the correct answer and treat accordingly, would probably reccommend a GA and proper exploration.  I hear that your cat didn't respond well to a sedative - were Oxygenation and fluid support given at the time?  Although a general-anaesthetic sounds like a big thing and sedation like a smaller one, the reverse is often true; a GA can offer more control because the airway can be kept open with a tube; a drip is generally placed to maintain circulating blood volume and the patient is unconscious, giving the vets the opportunity to give breaths etc if necessary.  They may also get a better picture.  Furthermore, GA drugs are often short-acting and stop influencing the body shortly after being administered, allowing for a surprisingly fast recovery.  Obviously this will not help a struggling liver, but fluids could help there and there is no known problem with the liver (although it depends on the nature of the bloods that were tested, how certain your vet can be about that).    This is something to ask your vet about, because of course I don't know enough about your cat - and of course, there is still some risk to a GA.......

The other school of thought is to say, 'You know what?  Our cat is very old and has lived a good life and we don't want to put him through the stress of investigations; let's maintain his quality of life as well as we can with symptomatic treatment.'  The risk with this approach is that if the condition is progressive, then as it gets worse you still can't be sure what's going on.  Or alternatively, if the problem was something that could have been helped more (e.g. a polyp that might have been temporarily removed), you may miss the chance.  This decision is like comparing swings with round-a-abouts; some decisions suit some families best and others suit others.  As vets, we are trained to want to get to the bottom as problems;  as pet-owners, we know that the decision is far more complicated.

It sounds, however, as though you have made a decision with which you are all satisfied; to treat symptomatically, for however long a happy, comfortable life can be sustained.  I'm afraid that my input ends here, as your vet is in a much better position to make recommendations for treatment options for an animal that they have examined, than I am.  One thing you haven't metioned is being aware of air quality at home;  keeping it clear of aeorols / irritants etc and perhaps considering wet, soft food as an alternative to the sort of biscuit that may produce dry or dusty 'bits.' I know that I haven't told you anything new there and that you have already considered this situation carefully, but sometimes it helps to chat around a subject.  Wishing you all the very best from here.

You asked about mucolytics;  it could be that the most effective ones are nebulised directly using an inhaler system.  These are generally helpful if mucous and in particular the thickness of it is what is holding your cats' breathing back; I'm afraid that given that it's your vet who has examined the patient, they would probably be the best person to ask.  Vets secretly like to be asked questions - and 'can you explain again why you reached the conclusion that a mucolytic wouldn't be helpful?'  is probably the simplest way to clarify things.  Wishing you and your loved one all the best; please will you come back and let us know how you get on?

While it may seem like sedation would be the more manageable option, the reality is that general anesthesia (GA) often provides greater control. This is due to the fact that the airway can be kept open with a tube, blood volume can be maintained through a drip, and the patient is unconscious, allowing the veterinarians to administer breaths and other necessary procedures while the patient is under GA. In addition, they might acquire a clearer image. In addition, GA medications often have a short half-life and cease to have an effect on the body not long after they are given, which enables for an unexpectedly rapid recuperation.