Pug Dog Brachycephalic Obstructive Airway Syndrome

Overview

Unfortunately, brachycephalic obstructive airway syndrome (BOAS) is very common with Pugs. Some studies show the rate of BOAS with Pugs as being as high as 90+%; however, this does not represent the number that have this condition severe enough to require surgery.

Understanding the Brachycephalic Profile

To best understand BOAS, it helps to have a clear view of what it means for a Pug to be a brachycephalic breed.

There are 3 main types of skulls that canines can have:

pug-brachycephalic-skull-compared-to-other-breeds

• Dolichocephalic (top image) - This shape has a thin, rounded skull and a relatively long snout that allows for lots of room for internal breathing passages. Some examples of breeds with this profile include Greyhounds and Whippets.

• Mesaticephalic (middle image) - With this shape, the skull and snout are each just about equal in length and dogs in this group are have ‘medium’ sized muzzles. Some examples of breeds with this profile include the Beagle and the Labrador.

• Brachycephalic (bottom image) - With this shape, a dog has a compressed jaw, a short muzzle, and a compact skull. This compressed shape causes the upper respiratory system to be compacted into a small area, which is why brachycephalic breeds like the Pug can have so many breathing issues. Aside from the Pug, the Shih Tzu and the Bulldog are a couple of other breeds in this classification.

Overview of Brachycephalic Obstructive Airway Syndrome

Brachycephalic Obstructive Airway Syndrome (BOAS) is a combination of two or more conditions, and in some cases secondary conditions, that affects the breathing passages and therefore the ability of a dog to breathe normally.

The four main conditions of BOAS that affect Pugs are:

1. Stenotic nares.

Stenotic Nares is the medical term for pinched nostrils. This is a congenital condition (present at birth) that is caused by inherited malformation of the cartilage in the nose. Essentially, the nostrils are too narrow which makes it difficult for a dog to draw in air. Approximately 50% of Pugs have stenotic nares to some degree and with those that do, approximately 50% also have elongated palate. Read more about Pug Dog Stenotic Nares.

2. Elongated soft palate.

The soft palate is a flap of skin located at the back of the throat. Because the internal structure of a Pug is compressed, the soft palate may be too large, relatively speaking, causing it to partially block the entrance to the trachea (windpipe), leading to breathing problems.

This is also a congenital condition (present at birth) and it is common for Pugs to have elongated soft palate to some degree due to the facial structure of this breed. This condition can range from very slight (which causes no symptoms), to moderate (which will cause some problems), to severe (which interferes with quality of life). Pugs with breathing problems as puppies should be examined for this issue, as it can worsen over time. Read more about Pug Dog Elongated Soft Palate.

3. Trachea issues.

This includes hypoplastic trachea and collapsed trachea.

Hypoplastic trachea involves an abnormality with the cartilage rings that make up the trachea (windpipe). There may be inadequate growth (underdeveloped or too small) or an issue where the rings are either fused together or overlap. In all cases, there is a narrowing of the trachea. The extent of this can vary from minor (very little narrowing that does not interfere much with breathing) to severe (serious breathing issues).

Collapsed trachea, not seen as often as hypoplastic trachea, involves one or more of the structural rings around the trachea collapsing inward, partially obstructing the breathing passage. Weakened tracheal rings can be genetic and may collapse via a trigger such as pressure on the neck or regardless. Or, this can be acquired which is linked to chronic respiratory disease, Cushing’s disease, and heart disease. Though the onset of this condition can be any age (and as young as 6-months old), the genetic type usually leads to collapsed trachea by the age of 6-years-old.

Read more about Pug Dog Trachea Issues.

4. Everted laryngeal saccules.

Laryngeal saccules are soft tissue masses that are located inside the throat, right above the vocal cords. With this conditioner, tissue masses become everted (inside-out) and protrude; negative pressure then causes the tissue to be drawn into the airway, partially obstructing airflow and a dog’s ability to breath. In severe cases, this condition can cause the cartilage that supports the larynx to collapse, which can cause a dog to suffocate.

In looking at all brachycephalic breeds with some level of brachycephalic obstructive airway syndrome, studies have shown 54 to 66% of those dogs had everted laryngeal saccules. Read more about Pug Dog Everted Laryngeal Saccules.

Secondary conditions include laryngeal (voice box) collapse and tonsillar eversion and hypertrophy.

Symptoms

The most common symptoms include:

• Trouble breathing (trying to catch their breath, struggling to take in enough air, etc.)

• Heavy panting

• Snoring

• Noisy breathing (grunting, gasping, rattling, or wheezing noises)

• Coughing

• Exercise intolerance due to breathing issues

• Trouble eating (gagging or regurgitating food)

• Collapse (in very severe cases, a dog may faint or collapse).

Degrees of BOAS with Pugs

There are four degrees (grades) of BOAS:

Grade 0: BOAS is not detected; further assessment at future check-ups is recommended.

Grade I: BOAS is detected, yet there are only minor clinical signs; further assessment at future check-ups will be needed.

Grade II: BOAS is detected with moderate clinical signs. Non-surgical management and treatment is needed.

Grade III: BOAS is detected with severe clinical signs. Surgical intervention is usually required.

Treatment

Since this condition involves more than one abnormality, treatment will depend on which issues a Pug has and to what extent.

Non-surgical treatment includes:

Excess weight gain prevention/weight loss. With puppies, a plan will be put in place to prevent future issues of possible excess weight gain. With older dogs, the vet will speak to you about any excess weight that your Pug may be carrying and devise a weight loss plan, if needed.
Immediate discontinuation of a collar. A collar will never be placed on the Pug again and a harness will be used instead, any time the dog is on leash. Harnesses are recommended at any rate for all Pugs to help prevent breathing issues. Read more about finding the right harness for a Pug.
Limit over-excitement. Introduction or exposure to elements that would normally excite a dog should be done in a gradual way and in a low-key manner.
Avoidance of exercise during hot, humid weather and follow exercise limitations year-round.
A bronchodilator, as needed.
NSAIDs (nonsteroidal anti-inflammatory drugs), which includes Rimadyl or Etogesic, may be given to help with pain and inflammation.
Corticosteroids, which includes prednisone, may be given to help reduce pain and inflammation. This may be given via an inhaler. This is given short-term and with careful monitoring due to possible severe side effects. Even with short-term use there may be increased thirst or appetite and risk of susceptibility to infections.
Antibiotics, to treat or prevent aspiration pneumonia.

Surgical treatment:

Corrective surgery for stenotic nares is rather straightforward and involves using a scalpel or surgical laser to remove a small piece of the wall of each nostril to widen the openings.

Corrective surgery for elongated palate is always recommended when breathing distress interferes with quality of life. This condition may worsen as a Pug matures, but if surgery can be held off until the 1-year mark it often is because if done during the puppy stage the palate may still grow and require another correction at a later date. The procedure involves using a surgical laser to shorten the palate.

Corrective surgery for hypoplastic or collapsed trachea may involve reinforcing the trachea by inserting a mesh-type sleeve and prosthetic polypropylene rings and is considered extremely high risk. All non-surgical treatment options will be attempted first.

Corrective surgery for everted laryngeal saccules involves using a laser to remove the saccules. Because everted laryngeal saccules are considered to be the first stage of laryngeal collapse (an often-fatal condition that causes a dog to suffocate) moderate to severe cases are treated in this way.

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