Welcome to another Wellness Wednesday at The Vet Vortex, where we decode your pet’s quirks with science, stories and a swirl of humour.
You’re sipping coffee at 5am when you hear it:
“HACK–HACK–HAAAAAACK–HURK!” then a damp "SPLAT!"
Your cat crouches low, neck extended, shoulders heaving. A cylindrical clump of moist fur lies accusingly on your carpet.
Congratulations - you’ve witnessed the classic hairball hack.
But here’s the catch: Not every coughing or hacking fit is a hairball.
Cats can also cough due to respiratory conditions. Differentiating between coughing (respiratory origin) and retching or gagging (gastrointestinal origin) is critical for your cat’s health.
What Is It?
Hairballs (Trichobezoars)
Cats are meticulous groomers. Their tongues, covered with backward-facing barbs (papillae) made of keratin, act like combs catching loose hair, which they swallow. Most hair passes harmlessly in poop. But sometimes, it clumps into a trichobezoar (fancy vet speak for hairball) and is vomited out. Long-haired breeds like Persians and Maine Coons are more prone, but any cat can join the hairball club.
Coughing Fits
True coughing, however, comes from the lungs, bronchi, or trachea, not the stomach. It’s a protective reflex to clear airways of irritants or mucus and often sounds like a dry, hacking cough with possible wheezing.
Knowing these differences is crucial for your feline overlord’s health.
How Does It Happen?
Hairballs: The Journey
1. Grooming: Cats spend up to 30-50% of their waking hours grooming. Their barbed tongues catch dead hairs efficiently - feline hygiene at its finest. However, excessive grooming from boredom, stress, skin irritation, fleas or allergies leads to swallowing more hair than usual.
2. Ingestion : Once hair is caught, it’s swallowed along with saliva and food particles, travelling down the oesophagus into the stomach. Cats can’t spit it out - once caught, it’s gone. Normally, small amounts mix with digesta and pass into the intestines to be excreted in faeces.
3. Compaction: If too much hair is swallowed or gut motility is sluggish (due to dehydration or conditions like inflammatory bowel disease - IBD), hair accumulates in the stomach. Over time, it compacts into a dense, cylindrical mass called trichobezoar (hairball).
Long-haired breeds: More fur ingested per grooming session.
Digestive motility issues: Gives hair more time to clump together.
Underlying skin diseases: Increase shedding, leading to higher hair ingestion.
4. Expulsion: When the hairball reaches a certain size or consistency and becomes too large to pass into the intestines. The cat’s body initiates a vomiting reflex to expel it.
Stomach wall detects irritation or stretch from the hairball.
Signals are sent to the vomiting centre in the brainstem.
The cat crouches, extends its neck and contracts its abdominal and stomach muscles.
The glottis closes momentarily, pressure builds, then it opens and the hairball is retched up.
The hairball is expelled onto your carpet, bed or favourite rug (because, of course, cats love drama).
Summary: Hairball FormationF
- Grooming: Barbed tongue catches and collects loose hairs.
- Ingestion: Hair is swallowed along with saliva.
- Compaction: Hair accumulates and clumps in the stomach due to excess ingestion or slowed gut motility.
- Expulsion: Stomach contractions retch the hairball out to prevent digestive blockage.
Coughing: The Triggers
Coughing is a reflex to clear irritants from airways. Here are common causes:
- Irritant receptors in the lining of the trachea and bronchi detect these particles.
- They send signals via the vagus nerve to the cough centre in the brainstem.
- The cough reflex is activated to expel the irritant.
- Infection damages the respiratory epithelium, causing inflammation and swelling.
- Mucus production increases to trap pathogens.
- Irritated receptors detect the excess mucus and inflammation, triggering coughing to clear the airways.
- Allergens cause immune cells in the airways to release inflammatory chemicals.
- This leads to bronchoconstriction (airway narrowing), swelling and mucus production.
- The narrowed, inflamed airways trigger the cough reflex to expel mucus and relieve irritation.
- Allergen exposure causes airway irritation and mild inflammation.
- Coughing occurs to clear inhaled allergens or mucus from the irritated airway lining.
- Larvae migrate through lung tissue, maturing into adult worms in the bronchi and alveoli.
- Their movement and presence irritate airway linings, causing inflammation, increased mucus and coughing to expel them or their secretions.
- Blood backs up into lung vessels, increasing pressure and causing fluid leakage into air spaces (pulmonary oedema).
- Fluid accumulation irritates the airways, triggering coughing to try to clear excess fluid from the lungs.
- The foreign body lodges in the trachea or bronchi, directly irritating the mucous membranes.
- This mechanical irritation triggers persistent coughing as the body attempts to expel the object.
In Summary: The Cough Reflex
- Stimulus: Irritant, infection, allergen, fluid, parasite or foreign body is present.
- Receptor Activation: Airway nerve endings detect the problem.
- Signal Transmission: Vagus nerve carries the signal to the brainstem.
Cough Reflex Sequence:
- Deep inhalation
- Glottis closes
- Abdominal and chest muscles contract, building pressure
- Glottis opens suddenly
- Air is forcefully expelled, carrying mucus, irritants or pathogens out.
Hairball Hack or Respiratory Cough? How to Tell the Difference
| Cough Type | What It Sounds Like | What You’ll See | Key Clue |
|---|---|---|---|
| 1. Hairball Hack Retching/Gagging | Deep, guttural hacking: “HACK–HACK–HURK!” Ends with a squelchy splat if hairball exits. | Cat crouches low, neck extended, shoulders + abdomen heave rhythmically, tongue may peek out. Produces a moist, furry tube (hairball). | Like vomiting, not coughing. No breathing trouble between hacks. |
| 2. Dry Hacking Cough Asthma, Allergies, Irritation | Dry, repetitive hack or wheeze. Similar to a human asthma cough. May gag foam or mucus (no hairball). | Open-mouth breathing or panting if severe, wheezing sounds, sits with neck up, elbows out to breathe. | Wheezing or breathing difficulty between coughs. Often triggered by dust, exercise, stress. |
| 3. Wet, Productive Cough Infections, Pneumonia | Moist, gurgly, congested cough. Like fluid moving in airways. May swallow after coughing up mucus. | Nasal discharge (clear, cloudy, or yucky), sneezing, lethargy, poor appetite, raspy breathing even at rest. | Wet cough + signs of general illness (fever, lethargy, nasal goo). |
| 4. Lungworm Cough Parasite Infections | Persistent dry or moist cough. Mild but chronic, like throat-clearing. | Weight loss despite eating fine, possible breathing trouble if severe, common in outdoor hunters. | History of hunting rodents or birds + chronic cough. |
| 5. Heart Disease Cough Pulmonary Oedema | Soft, moist, “gurgly” cough (fluid in lungs). Less common in cats than dogs. | Laboured breathing at rest, open-mouth breathing, pale/blue gums, weakness or collapse if bad. | Breathing difficulty + lethargy or fainting alongside coughing. |
| 6. Foreign Body Inhalation | Sudden harsh, hacking, persistent cough. May be high-pitched if airway partly blocked. | Restless, distressed, pawing at mouth or rubbing face, possible gagging if near larynx. | Sudden onset after chewing grass or playing with small items. |
| 7. Allergic Cough Mild Irritation | Short, dry, mild cough. Often intermittent. | Otherwise normal behaviour and breathing, may have sneezing or watery eyes. | Short-lived, mild, no wheezing or distress. |
Personal Story: Miso’s Midnight Opera
Let me tell you about Miso, my neighbour’s chubby tabby. One silent night, I woke up thinking a gremlin was being exorcised outside. Turns out, Miso was hacking repeatedly, eyes wide, tongue out, no hairball produced. His mum thought it was just a stubborn hairball, but my vet brain screamed "Possible asthma attack!"
Long story short, he was rushed to the clinic and diagnosed with feline asthma. Now he’s on inhaler therapy and rules his kingdom in wheeze-free peace.
What Can Pet Parents Do?
- Observe carefully: Differentiate hairball retching from true coughing.
- Record details:
- Frequency and duration
- Presence of wheezing, open-mouth breathing, blue gums
- Lack of appetite or lethargy
- Prevent hairballs:
- Regular grooming, especially for long-haired cats
- Hairball diets or lubricating treats (consult your vet first)
- Hydration to aid gut motility
When Should You Call the Vet?
Seek urgent care if:
- Noisy breathing or wheezing
- Open-mouth breathing
- Gagging without producing anything
- Weakness, collapse, blue-tinged gums
- Persistent coughing fits (more than occasional hairball hacking)
When In Doubt, Film It
Take a quick video of the episode to show your vet. It helps differentiate causes far better than descriptions alone.
What Can The Vet Do?
Diagnostic Work-Up
- History & Examination: Questions about grooming habits, frequency of episodes, environment, exposure to smoke or other cats.
- Chest X-rays: To check for asthma patterns, infections, fluid accumulation, tumours or foreign bodies.
- Fecal Testing: Baermann’s test for lungworm larvae.
- Blood Tests: To assess overall health, infection or heart function.
- Auscultation: Listening for wheezes, crackles or muffled heart/lung sounds.
Treatment
Treatment is targeted.
Hairballs:
- Hairball diets: Switch to special hairball-control diets with higher fibre content to help sweep hair smoothly through the digestive tract.
- Hairball laxatives: Place petroleum-based lubricants/gels on your cat’s paw or directly into their mouth (brands like Laxatone). Your cat licks it off and it acts as a lubricant in the gut.
- Rule out excessive grooming causes
- Ecto-parasites (flea, ticks, lice) - Use routine ectoparasiticides (spot-ons, collars, oral preventives) as recommended by your vet to eliminate skin irritation from parasites.
- Intestinal Worms - Follow a regular deworming schedule. Worm infestations can cause general discomfort, leading to increased grooming.
- Skin Infections (Bacterial or Fungal) - Veterinary-prescribed antibiotics or antifungals will treat infections causing itching and overgrooming.
- Boredom or Anxiety - Provide mental stimulation and environmental enrichment (toys, play sessions, puzzle feeders) to reduce stress-induced overgrooming.
Coughing:
- Feline Asthma: Corticosteroids (oral or inhaled) ± bronchodilators
- Infections: Antibiotics (if bacterial cause confirmed)
- Lungworms: Deworming medication (e.g. fenbendazole)
- Heart Disease: Cardiac medications, diuretics
- Foreign Body: Endoscopic or surgical removal
Hairballs may require dietary adjustments or laxatives; respiratory conditions need medications, environmental control or even lifelong management plans.
When Hairballs Won’t Come Out
Hairballs That Can't Be Coughed Out
Sometimes, hairballs become so large and compacted that they form a trichobezoar (hair mass) obstructing the stomach or intestines. In these rare but serious cases, dietary adjustments and laxatives alone won’t help.
Surgical Removal (Gastrotomy or Enterotomy)
Nuances to Know:
- Pre-Surgical Stabilisation: Cats may be dehydrated or electrolyte-depleted from vomiting; vets will stabilise them with IV fluids first.
- Procedure: Depending on hairball location, vets perform a gastrotomy (opening the stomach) or enterotomy (opening the intestine) under general anaesthesia.
- Risks: As with any abdominal surgery, risks include infection, leakage from surgical sites and anaesthetic complications, especially in older or debilitated cats.
- Recovery: Cats generally recover well with pain management, strict rest and gradual reintroduction to food.
- Future Prevention: Dietary fibre, hairball laxatives and regular grooming become even more critical post-surgery to prevent recurrence.
Prevention
- Groom Regularly: Daily brushing, especially for long-haired cats
- Hydration: Encourages gut motility
- Hairball Control Diets: Formulated to aid passage of hair
- Environmental Management: Reduce dust, aerosols, cigarette smoke to lower asthma risk
- Routine Deworming: Every 3 months (or as advised) to prevent lungworms
- Stress Management: Enrichment, play, scratching posts to reduce overgrooming from anxiety
- Maintain good indoor air quality: to reduce dust, aerosols, smoke
Why Prevention Matters
While hairballs are a normal byproduct of grooming, frequent or unproductive retching can indicate gastrointestinal issues or excessive grooming from underlying skin or behavioural conditions.
Prognosis
- Hairballs: Excellent with management.
- Respiratory issues: Varies.
- Feline asthma is chronic but manageable;
- Infections, excellent often resolve with treatment;
- Heart disease, guarded to fair - depends on severity and response to treatment;
- Foreign body, good if removed promptly - delays can be life-threatening.
Zoonotic Implications: Do Hairballs Occur in Humans?
Yes; hairballs (trichobezoars) do occur in humans.
But they’re not zoonotic.
In humans, these are usually seen in individuals with trichophagia, a psychological condition where a person compulsively eats their own hair, often linked to trichotillomania (hair-pulling disorder). Over time, ingested hair accumulates in the stomach, forming a dense mass called a trichobezoar, and when it extends into the intestines, it’s termed Rapunzel syndrome. Unlike cats, humans don’t groom themselves to ingest hair, so these cases are behavioural rather than hygienic, requiring surgical removal and psychological therapy to prevent recurrence.
Therefore, while both cats and humans can develop hairballs, they are not infectious or transmitted between species.
In contrast, most causes of coughing in cats pose minimal risk to people. One very rare exception is lungworm infections (Aelurostrongylus abstrusus), which have rarely been reported in humans, particularly in immunocompromised individuals. Good hygiene, regular deworming and prompt vet care help minimise this already low zoonotic risk.
Quick Takeaway:
Cat coughing fits aren’t always hairball dramas. Sometimes, they’re tiny feline alarms for bigger health issues.
Know the difference.
Over To You:
Stay tuned for next week’s Wellness Wednesday, where we unravel “Senior Cats and Weight Loss: Aging Gracefully or Cause for Alarm?”
Stay vortexy, stay observant and hug your feline overlords today.
Check out previous post - Big Data in Shelter Medicine: Reducing Euthanasia Rates