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Trachea issues

Pug Dog Hypoplastic Trachea
and Collapsed Trachea 

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Overview 

Pugs are prone to brachycephalic obstructive airway syndrome (BOAS) which is a term given when a brachycephalic breed like the Pug has two or more breathing-related issues linked to their body structure which includes elongated palate, stenotic nares, everted laryngeal saccules, and tracheal issues including hypoplastic trachea and collapsed trachea. 

The trachea, also known as the windpipe, is the passage through which air is inhaled and exhaled so, of course, any abnormality will directly influence a Pug's ability to breathe well.  

This section will cover:
Hypoplastic Trachea - Of the two tracheal issues seen with Pugs, this is the most common.
Collapsed Trachea - Though not as common, this is a serious issue to be aware of.
How to Help Prevent Trachea Issues - The most effective methods to protect the neck and trachea from injury and allow a Pug to breathe as freely as possible.

Hypoplastic Trachea 

Overview

Hypoplastic trachea is a congenital condition which means it is present at birth. This involves an abnormality of the windpipe causing it to be too narrow for proper air flow. The extent of this can vary from minor (slight narrowing that does not interfere with breathing) to severe (very serious breathing issues). The reason behind the abnormally narrow trachea includes inadequate growth and/or a deformity of rings fused together or overlapping. 
Occurrence Rate
Pugs are at a moderate risk for this.
Age of Onset
Hypoplastic trachea is congenial condition meaning it is present at birth; however, symptoms may not be immediately apparent. With minor cases, it can be weeks or months before symptoms are very apparent. Moderate to severe cases are often diagnosed early, within the first weeks or first couple of months. The median age of diagnosis is 5 months old.
Symptoms
Signs include one or more of the following: 
  • Trouble eating (gagging on or regurgitating food)
  • Noisy breathing (gasping, rattling, or wheezing noises)
  • Coughing, sometimes with mucus 
  • Gasping for breath
  • Symptoms may worsen during or after exercise or when excited
  • Cyanosis (low oxygen levels may cause gums to turn blue; seen in severe cases)
  • Collapse, fainting (seen in very severe cases)
  • Aspiration pneumonia, as a secondary issue (regurgitated mucus is inhaled back into the lungs)
How this is Diagnosed
This is diagnosed via x-rays. Additional tests may include a complete blood count and biochemistry, and arterial blood gas (ABG) to measure acidity (pH) and levels of oxygen and carbon dioxide in the blood.
Treatment
Though hypoplastic trachea can create serious breathing issues, non-surgical treatment can offer some level of improvement in up to 70% of cases. And, in some cases, a puppy diagnosed with minor to moderate hypoplastic trachea can outgrow this. 

Treatment involves keeping a Pug at a healthy weight, taking precautions in regard to physical exercise, limiting excitement, and a range of OTC and prescribed medications. For the full list of treatments for hypoplastic trachea see 'Collapsed Trachea - Treatment' below since the list is identical. 

Collapsed Trachea

Overview

The (trachea) is surrounded by c-shaped rings of cartilage that allow the neck to be flexible. As the name implies, collapsed trachea is a condition in which one or more rings collapse inward. This obstructs the breathing passage to varying degrees, interfering with breathing and causing internal swelling and pain. 

Weakened tracheal rings can be genetic or acquired. With the genetic form, collapse may occur at any rate but can be triggered by pressure and stress placed on the neck. The acquired form is linked to certain health issues including chronic respiratory disease, Cushing’s disease, and heart disease. 
Occurrence Rate

Though not seen as often as hypoplastic trachea, collapsed trachea is an issue to be aware of. 
Age of Onset

The acquired type can develop or occur at any age and the genetic type generally is apparent by the age of 6. 
Symptoms
  • A distinctive honking-type cough is the #1 sign and can be one of the most troubling symptoms. When coughing, the neck may be extended and a dog may take a stance with elbows spread as if struggling to cough something up. Generally, coughing progressively 
  • worsens.
  • Trouble eating (gagging on or regurgitating food)
  • Noisy breathing (gasping, rattling, or wheezing noises)
  • Coughing, sometimes with mucus 
  • Gasping for breath
  • Symptoms may be more apparent during/after exercise, when excited, or when breathing in cold air
  • Cyanosis (gums turn blue; seen in severe cases)
  • Collapse, fainting (seen in very severe cases)
  • Aspiration pneumonia, as a secondary issue (regurgitated mucus is inhaled back into the lungs)
How This is Diagnosed
Most experienced veterinarians will recognize the honking-type cough and immediately suspect collapsed trachea. X-rays generally confirm this. In some cases, x-rays will be inconclusive; in these instances, if the clinical symptoms are there, a dog can still be treated for this. If you desire confirmation, you can ask for a fluoroscopy which allows real-time visualization of the trachea as a dog inhales and exhales. 
Grades of Collapse
With a diagnosis, the degree of collapse will be graded: 

Grade I: The tracheal membrane hangs slightly, cartilage maintains normal shape, the tracheal opening (lumen) is reduced by approximately 25%. 

Grade II: The tracheal membrane is widened and hanging, cartilage is partially flattened, the tracheal opening (lumen) is reduced by approximately 50%.

Grade III: The tracheal membrane is almost in contact with dorsal trachea (the opposite side of the windpipe), cartilage is nearly flat, the tracheal opening (lumen) is reduced by approximately 75%.

Grade IV: The tracheal membrane is lying on dorsal cartilage (is completely touching the opposite side of the windpipe), cartilage is flattened and may invert, the tracheal opening (lumen) is essentially closed. 
Treatment; Non-Surgical

Ongoing studies show that improvement is seen with approximately 70% of dogs managed with a non-surgical treatment plan. 

This includes:

1. Excess weight gain prevention/weight loss since obesity puts a strain on the respiratory system. With puppies, a plan will be put in place to prevent future issues of possible excess weight gain which includes careful monitoring of food intake and meeting exercise requirement. With older dogs, the veterinarian will speak to you about any excess weight that your Pug may be carrying and devise a weight loss plan if needed. Helping a Pug lose weight will involve a low-calorie diet. Depending on a Pug's capacity for physical activity, this may also involve low-cardio exercise such as slow walks several times per day. 
2. Immediate discontinuation of a collar. Because collars sit right on the trachea, putting direct stress onto the area, these will never be worn again, either on or off leash. When a Pug is on a leash, a harness will be used instead. These leave the neck free and instead distribute pressure over the much stronger and more muscles chest, shoulders, and back. Details about harnesses are coming up under 'How to Help Prevent Tracheal Issues'. 

3. Limiting over-excitement. This involves keeping stimuli that would normally get a Pug excited to a minimum to help prevent heavy breathing. Introductions to other dogs or people may need to be done in a calm, gradual way and such things as offering new toys, etc., should be done in a relaxed manner. Households should be kept peaceful (no yelling, no commotion, no chronic loud noises, etc.). 
4. Avoidance of exercise during hot, humid weather; maintain exercise restrictions year-round. During the summer, activity may need to be limited or adjusted. Year-round, careful monitoring must be done to ensure that a dog is not overexerting himself. 

5. A smoke-free, irritant-free household environment. There should be no smoking and no use of airborne cleansers or deodorizers. If pollen is a known issue running central air systems with a HEPA filter or using standalone air purifiers can help keep the air clean. 

6. Bronchodilator, as needed.  

7. NSAIDs (nonsteroidal anti-inflammatory drugs) such as Rimadyl or Etogesic can help with pain and inflammation. 

8. Corticosteroids such as prednisone may be given, which works to reduce pain and inflammation. This may be given orally or via an inhaler. This is given short-term and with careful monitoring due to possible severe side effects. Even with short-term use, there can increased thirst or appetite and risk of susceptibility to infections. 

9. Antibiotics, to treat or prevent aspiration pneumonia. 

10. With severe cases in which breathing distress greatly interferes with quality of life, treatment does not offer relief, and surgery is not deemed viable, the veterinarian may recommend euthanasia. 
Treatment; Surgical
Overview:

Surgery is an extraordinarily invasive and extensive procedure; all possible non-surgical treatments should first be implemented. Surgery involves using a mesh-type sleeve to reinforce the trachea, sometimes along with prosthetic polypropylene rings.

Prognosis: 

The success rate of this surgery can be as high as 75%, though recovery is quite lengthy and there are serious risks including bleeding, laryngeal paralysis, and/or severe internal swelling that can be fatal. Dogs under the age of 6 are more likely to have a good prognosis. 

How to Help Prevent Trachea Issues

The majority of Pugs have some level of stenotic nares (narrow nostrils that prevent good air flow) and/or elongated soft palate (tissue at the back of the roof of the mouth partially blocks the tracheal opening), two issues that affect this breed's ability to breath. Even without a tracheal issue, this means that certain steps should be taken to help a Pug breath as freely as possible. When you add in the chance of either hypoplastic or collapsed trachea, these steps become even more vital. 

1. Use a harness, not a collar. Even single Pug, no matter their health status, should never be walked on leash and collar. Collars place direct pressure onto the windpipe and larynx. Any stress or tension from the leash goes to a Pug's most vulnerable area, exacerbating issues and even trigger new problems, including very serious ones. 
The good news is that the right harness can be extremely comfortable, easy to place on, and give you better control when walking your Pug. For example, the Puppia Soft B Harness Vest is a step-in design which means that nothing needs to be slipped over the head, it is adjustable for a great fit, closes up on the back with a Velcro flap, and is made of air-mesh to help keep a dog cool. 
2. Find the right balance of activity. Pugs need regular exercise to help maintain a healthy weight but exercise done at too brisk of a pace or for too long of a time, particularly during hot and humid weather can put strain on the respiratory system. Aim to walk your Pug at least twice per day for at least 20 minutes and add in some free-run activity like playing fetch. Just be sure to take breaks as needed, hydrate as needed, and avoid heading out during the hottest parts of the day in the summertime. 
3. Offer a quality bed that has raised bolsters which can help a Pug find a good sleeping position and stretch out their neck to open breathing passages. This can also cut down on snoring. An added benefit of providing a good dog bed is that it will offer the orthopedic support that this breed needs due to being prone to joint and hip issues. 
A good choice is the JOYELF Memory Foam Dog Bed which has firm bolsters, a quality memory foam base, and an inner waterproof cover. 
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Other helpful articles:

Pug Dog Grooming - An overview of every grooming task that needs to be done to keep a Pug clean and well-groomed. 
Pug Separation Anxiety - Ways to help a Pug cope better, stay occupied, and be more relaxed when home alone. 
Taking Care of a Pug's Teeth - It's very important to keep your Pug's teeth clean and free of plaque. This can usually be accomplished at home if these tasks are done on time. 
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