Lungworm!

Due to the very wet summer we are having, there are loads of slugs and snails around, so I have decided to give my dogs a 7 day course of panacur. Zazzy has had a very nasty neurological reaction the night after treating her with advocate, she had the same reaction when I left her untreated but applied it to my other dogs, so I will not use it again. It does concern me that other dogs may be reacting in a similar way, but it may not be seen unless you sleep in the same room as your dog. Anyway, here is a very interesting article on the blog of Nick Thompson, a vet http://blog.holisticvet.co.uk/2012/07/13/are-we-lungworm-aware-or-lungworm-advertising-aware/
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You can’t move at the moment for pictures of cute puppies looking at snails on their artificial chewy bones. The consequence of this multimedia onslaught is that I’m frequently asked what the actual risk of getting disease from lungworm, Angiostrongylus vasorum, is. I didn’t have any accurate figures, so I thought I’d do some research.
It seems, after extensive investigation, and talking to industry insiders, that there is ‘no hard science on the actual level of infection in the UK’. The industry also don’t know how many dogs with lungworm get clinical disease (breathing, circulation, neurological or gut problems). i.e. if 100 dogs had evidence of lungworm on poo samples, they don’t know how many of those would go on to get actual disease, and how quickly.
There is one scientific paper on the subject, published by Bristol University in 2010 (see Ref), part funded by Novartis, who make Milbemax, a lungworm-active wormer, describing a study that looked at sick dogs in the South West area (an area known to be endemic for lungworm) whose diseases were not a ‘specific non-parasitological diagnosis’, i.e. unclear cases.
Of these, 16% of the dogs were found to be positive for lungworm on a single stool test (more would have been found had they used the best test – a 3 days’ stool, non-pooled sample). They don’t say that the diseases they found were definitely due to lungworm as we don’t know what happened after the dogs were treated for lungworm, unfortunately.
So that’s it. A solitary UK study in an endemic area, part-supported by a worming company, and we don’t know if any of the diseases in any of the dogs was actually due to lungworm.
Everything else we see in the media or hear from professionals is opinion, conjecture or extrapolation from other countries. You wouldn’t think the evidence was so flimsy if you looked at all the television, magazine and internet advertising, would you?
Treatment
The conventional recommended treatment is to use Advocate spot-on (pesticide) continually, and use Milbemax pharmactutical worming tablet every month. A pesticide and a drug every month, ‘just in case’ you get a disease, the incidence of which, in the whole of the UK, we have not a clue and the incidence of subsequent disease we know even less; a bit hit-and-miss, I feel.
In my practice, I’m going to take a pragmatic view. I’m in Bath, in the South West, so I’m going to assume all dogs coming to me from this area may have exposure, therefore I’m going to advise all my dog clients to get a Baermann worm egg count done on 3 days’ stool samples every six months to see if lungworm is present. If it is, I’ll recommend they have a seven day course of Panacur. If they don’t, I’ll recommend they use a herbal product prophylactically (my preference is Verm-X crunchies daily) for intestinal hygiene control between tests.
I will not, unless absolutely necessary, be using monthly pharmaceuticals until the evidence becomes a little more convincing. We are, after all, a profession led by EBM, Evidence Based Medicine, not glossy adverts.'

Ref: Morgan, E.R., et al., Angiostrongylus vasorum infection in dogs: Presentation and risk factors. Vet. Parasitol. (2010), doi:10.1016/j.vetpar.2010.06.037