0.1ml of a 1:250 dilution of F10SC is inserted into each nostril daily. This has the effect of physically clearing discharges and, thanks to the open palate of allowing the disinfectant with anti-viral and anti-bacterial properties to penetrate the oral cavity as well as respiratory passages. In tortoise URTD much of the problem is, in fact, oral.

When the nasal passages are blocked with pus it is useful to perform a nasal flush. Again a 1:250 dilution of F10SC is used and 1ml is syringed into each nostril.

This technique is useful for both upper and lower respiratory disease. It enables:

While this is probably true for URTD there is some doubt about this in LRTD. Certainly where there is lung consolidation or abscessation, nebulisation may have little ability to penetrate the lesions. However, other effects of nebulisation may still have benefits in these cases.

Nebulisation acts as an excellent expectorant and aids greatly in the clearing of discharges. In snakes, nebulisation should be combined with coupage as, in the author's experience, it makes loosening of discharges and tracheal blockage more likely unless aid is given in expelling these materials.

As anyone who has suffered from a cold while flying or sitting in air conditioned rooms will tell you, drying of mucous membranes is uncomfortable and has the effect of allowing infection to penetrate deeper. Keeping membranes hydrated provides a "feel good" as well as assisting in membrane integrity.

The simplest means of providing some of these aims is "steaming" and for many rabbits or parrots with problems, being placed in a steamy bathroom provides some short-term relief. This is, however, not along-term answer nor should drugs be "steamed" into patients as the heat and uncertain delivery system will result in underdosing.

Aromatics such as Olbas Oil should also be avoided as it is very easy to overdose these biologically active compounds in small animals.

There are many drugs proposed as suitable for nebulisation. Often,  in  avian   medicine,  this   have  been  used  as  a  route for systemically toxic drugs (eg, gentamycin or amphotericin)  as  absorption   from   the air  sacs  is  poor.  While  this  is  great  for  the  patient  it does  raise  huge  Health  and  Safety  issues - someone has  to  get  the   patient   out   of   the nebulisation  chamber!   Also,  it  is  very  unwise  to send  home  a bird   on   nebulisation   therapy   if   the  nebulised   drugs  could   be   toxic   to   the  owner.  As  aspergillosis   therapy    typically   lasts   at

least six months this can mean a very long hospitalisation period.

We have, therefore, used F10SC in this situation as well. In South Africa it has good human safety trial results and appears relatively safe to users. It is also broad-spectrum in activity and surfactant inclusion benefits its properties as an expectorant.

A 1:250 dilution is again used and nebulisation periods of 20-45 minutes 2-3 times daily are used depending on species and condition.

Typical human asthmatics' nebulisers are often effective in this therapy. While many texts advise use of ultrasonic nebulisers producing very small droplets however, for most situations this is un-necessary. Aspergillosis in birds is one of the most common reasons for this type of therapy. The spores of this fungus measure 2-5 microns in diameter. Therefore it is unnecessary for the nebulisers to produce droplets smaller than 2 microns in order for the agents to penetrate as far as the spores. Where fungal spread has entered air passages narrower than this, there will generally be such consolidation that nebulisation alone would not be effective.

Penetration can be aided by providing direct access routes - in birds air sac cannulae can be placed (Fig 7), while in chelonia holes can be drilled into the shell allowing opening of pulmonary abscesses and drug to enter consolidated lungs (Fig 5a).

A chamber is easy to construct. In the clinic, solid fronted cages or kennels can be used (Fig 8) while at home a simple front-opening cat carrier covered in plastic is ideal. It is often apparent that patients "enjoy" nebulisation and actively sit over the unit rather than retreat away from it. In the home environment most owners find that, once the bird is used to the process, it becomes a simple routine rather than a fight.

Respiratory problems are often frustrating in diagnosis and therapy. Attention to underlying causes and multimodal therapies have greatly helped in improving treatment success rates.

Manufacturer of F10 Products:
Health and Hygiene (Pty) Ltd
P.O. Box 347, Sunninghill, 2157, South Africa
Tel: +27 11 474 1668 • Fax: +27 11 474 1670
www.healthandhygiene.co.za • www.f10products.co.za