A common misunderstanding about cats is the belief that coughing equals hairballs. This misconception – particularly by pet owners – is clinically relevant and can delay diagnosing significant lower airway diseases such as feline asthma or chronic bronchitis.
Coughing is not caused by a hairball issue, it is a sign of lower respiratory tract disease. Hairballs form in the stomach and they are expelled from the body through vomiting, not coughing. The physical evidence of hair within vomitus is consistent with a diagnosis of a hairball.
Cats with asthma or chronic bronchitis commonly have increased mucus production in the lower airways. When they cough, they may bring mucus up and then swallow it. From an owner’s perspective, it can look as if the cat “tried to cough up a hairball but swallowed it.” In reality, the cat is swallowing mucus, not hair. This video (courtesy of Susan Little, DVM, DABVP (Feline Medicine)) illustrates coughing followed by swallowing in a cat with asthma:
Cats normally spend roughly 25% of their waking hours grooming, but this can increase significantly in animals with underlying dermatologic or behavioral problems. Frequent vomiting of hairballs should not be disregarded and written off as “normal.” Hairballs form due to the ingestion of excessive amounts of hair and/or underlying GI disease. Differential diagnoses should include:
Dietary intolerance or chronic inflammatory enteropathy
Ectoparasites (e.g. fleas)
Itch associated with skin disease
Overgrooming due to pain or anxiety
Hairballs that are not removed from the body (through vomiting) can lead to other serious problems, including:
Intestinal obstruction
Esophagitis or esophageal obstruction
Upper respiratory inflammation due to retention of vomitus in the nasopharynx
Management of cats with hairball issues should focus on improving GI transit and reducing hair ingestion:
Feed smaller, more frequent meals to enhance gastric emptying
Use canned diets or round-shaped kibble, which tend to clear the stomach more efficiently
Consider commercial hairball control diets
Address skin disease, ectoparasites, pain, or anxiety
Grooming or clipping long-haired cats (who vomit hairballs about twice as often as short-haired cats)
Gastric lubricants and, when appropriate, medical management with prokinetic agents
Dietary manipulation and grooming are first-line strategies and should be tried before initiating medications.
This distinction between coughing and vomiting is really important, and the majority of cat owners cannot tell one from the other. Because owners often think that hairballs are normal, they may not mention them to their veterinarian. During preventive care visits, veterinary professionals should routinely inquire -“Does your cat have hairballs?” The answer to that simple question could be very revealing and lead to efforts that could dramatically improve a cat’s quality of life.
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