We see a lot of dog breeds with squishy noses or short muzzles such as French Bulldogs, Pugs, Boston Terriers, Boxers and Bulldogs here in Richmond. These breeds of dogs often suffer from a condition called Brachycephalic Airway Syndrome.

What is Brachycephalic Airway Syndrome?

The word brachycephalic stems from the Greek roots brachy meaning ‘short’, and cephalic meaning ‘relating to the head’. Brachycephalic airway syndrome (BAS) is a set of abnormal physical and functional airway traits that affects short or snub-nosed breeds of dogs, causing a degree of obstruction to the breathing. Brachycephalic breeds of dog have been bred for a particular cosmetic appearance that can come with some compromises to the structure of their airways. Fortunately, most dogs do not suffer from all aspects of BAS, but you should be aware of which traits are possible in your pet.

Primary Conditions

There are several primary conformational traits present in brachycephalic pets that can impede airflow through the upper airways. These primary conditions include narrow nostrils, a long soft palate and a narrow windpipe. Although these traits are a common finding, they reduce normal airflow in the upper airways with serious consequences. With time, and without correction, these primary conditions may lead to secondary, irreversible disease, such as laryngeal collapse.

Stenotic Nares:

Stenotic nares are narrowed nostrils, which tend to collapse inwards during inhalation (breathing air inwards), resulting in difficulty breathing through the nose. This condition is found in 50 – 85% of dogs with BAS.

Elongated Soft Palate:

Because brachycephalic dogs have a relatively ‘squashed’ face, it can be difficult for all the soft tissues of the mouth and throat to fit in an anatomically acceptable way. As a result, the soft palate, which divides the back of the nose from the back of the mouth, can flap loosely in the throat creating snorting sounds. Excessive barking, exercise or panting may lead to inflammation and thickening of the soft palate that can irreversibly worsen over time. In humans the soft palate is the fleshy area at the back of the roof of the mouth. Approximately 90% of brachycephalic dogs will have an elongated soft palate.

Tracheal Stenosis, Hypoplastic Trachea:

The trachea is the ‘windpipe’, and can be very narrowed along certain sections, especially during inhalation. This is a congenital condition, with English Bulldogs more frequently affected. Brachycephalic breeds in general have a narrower trachea compared to other breeds.

Secondary Conditions

The secondary changes found in brachycephalic airway disease develop due to the resistance to airflow when the pet breathes inward. The pressure this places overtime leads to chronic problems. The larynx and supporting structures become weakened, and the below problems can occur:

• Everted Laryngeal Saccules
• Laryngeal Oedema
• Collapsing Larynx
• Collapsing Trachea

The above traits all contribute to upper respiratory obstructions in the brachycephalic dog, causing them to breathe and pant inefficiently. In dogs, panting is an important behaviour that helps cool the body. As they need to put in so much extra work to be able to get breathe, this can cause inflammation and swelling making it even harder to breathe. Sometimes leading to the emergency situation of respiratory distress and heat stroke – of which, brachycephalic-shaped dogs are at the highest risk.

How can we help dogs with Brachycephalic Airway Syndrome?

For all of our brachycephalic pets, we need to ensure that we are mindful about certain aspects of their lifestyle:

• Minimise stress where possible.
• Provide an environment that is of comfortable temperature, eg a cool environment in summer. Be extra careful during hot days so that your dog is not at risk of heat stroke. Provide plenty of water, good air flow in the room, shade, ice blocks, etc.
• Allow for appropriate levels of exercise. That is, not too little to cause weight gain, yet not too much to cause excessive panting and excitement.
• Ensure your pet is of ideal weight.
• Be aware of the level of breathing noise that is ‘normal’ for your pet, and get in touch with your veterinarian if they worsen.

Brachycephalic Airway Surgeries

BAS is progressive if it is not prevented, corrected, or at least managed from an early age eg in puppies between 4 to 5 months of age. The two most common surgeries performed are rhinoplasty and palatoplasty.

Rhinoplasty – Nare Wedge Resection:

This is a simple surgical procedure where the goal is to increase the diameter of the nostrils to address the stenotic nares and allow for better airflow to occur during breathing. A small triangular wedge shape is snipped away from the outside tissues of each nostril, and then small temporary stitches are placed to heal the wound. The cosmetic results are very good.

Palatoplasty – Soft Palate Resection:

This is another one best performed at a young age, which is when the soft palate tissues are hopefully minimally swollen and thickened, and other secondary airway changes have not established themselves too well. The excess length of soft palate is trimmed away during this surgery. Post-operatively, 85 – 90% of dogs exhibit improvement, although some may still have breathing noises or snore during naps.

What other problems can affect brachycephalic pets?

A large proportion of dogs with brachycephalic airway disease will also suffer gastrointestinal problems. The increased effort required to breathe in these patients leads to high negative pressure in the gastrointestinal tract as well as the airways. Brachycephalic pets are also prone to some congenital and developmental abnormalities that affect the oesophagus (food pipe), stomach and intestines. These conditions include:

• Oesophageal deviation – Shifting of the foodpipe from its normal position in the chest
• Hiatal hernia – The stomach slides forward into the chest with breathing
• Pyloric Stenosis – Narrowing of the outflow track of the stomach

Patients with gastrointestinal involvement may show signs of:

• Vomiting
• Regurgitation of food
• Difficulty swallowing or eating
• Increased salivation/drooling

The gastrointestinal effects of brachycephalic disease may be managed with medical therapy, such as antacids and specialised diets. However often correcting the brachycephalic airway abnormalities can improve and even often resolve many of these gastrointestinal signs.

Further information

More specific management of BAS depends on the individual patient – their age, the severity, symptoms shown, duration, etc . The key to success is early intervention

Contact us and visit with our vets who will tailor a management plan for your Fur-kids unique needs.