Health Concerns (Brachycephalic Breeds) in Dogs

Often, the problems that result from the abnormal head formation of brachycephalic breeds is called Brachycephalic Syndrome or Brachycephalic Obstructive Airway Syndrome (BOAS). These terms refer not only to the resulting breathing and other physical difficulties, but also to the physical characteristics of an elongated soft palate which can block the trachea, stenotic snares, or abnormal nostrils that are too narrow and can collapse during inhalation, and everted laryngeal saccules, or tissue that is pulled into the trachea and blocks airflow during breathing. All brachycephalic dogs have BOAS to some degree. While some may not be severely affected, others can experience debilitating effects, such as in the case of many English Bulldogs.

Brachycephalic breeds are dog breeds that have been bred to have certain characteristic features that have become standard for those breeds. Features that include short muzzles and noses that give a pushed in appearance, shortened skull bones, shallow eye sockets that cause bulging eyes, and a compressed upper jaw predispose these dogs to breathing difficulties due to shortened and obstructed airways, as well as other physical problems. Sometimes called “smashed nose” breeds, brachycephalic breeds include Bulldogs, Pugs, and Boston Terriers.

Symptoms of a problem in your brachycephalic dog can often go unnoticed, as troubles breathing and bulging eyes that are prone to issues are seen as normal for the breed. They are, in fact, the beginning of severe conditions that will progressively worsen with time, and can affect other areas of the body, such as the gastrointestinal tract and the heart. Signs can become severe by 1 year of age, and will be lifelong problems for your dog. Symptoms of a health issue in your dog can include:

• Noisy breathing
• Labored breathing
• Breathing difficulties during exercise, including short walks 
• Choking
• Decreased exercise tolerance
• Breathlessness
• Snoring 
• Snorting 
• Inefficient panting
• Overheating
• Cyanosis, or blue gums and tongue due to lack of oxygen 
• Frequent lip licking
• Coughing 
• Gagging 
• Vomiting 
• Sleep problems
• Prefers to sleep on back 
• Obesity 
• Watery eyes
• Dry eyes
• Eye irritation
• Eyelids partially open during sleep
• Eyelid curling
• Squinting 
• Teeth crowding 
• Redness, irritation, and yeast growth in facial folds
• Fainting
• Collapse, commonly after excitement, exercise, or exposure to excessive heat

Types

The kinds of health concerns owners of brachycephalic breeds should be monitoring for include:

• Breathing difficulties, termed Brachycephalic Obstructive Airway Syndrome (BOAS)
• Difficulties swallowing due to tracheal obstructions
• Trouble sleeping 
• Higher risk of heat stroke due to the inability to pant efficiently 
• Eye problems due to shallow eye sockets, which can include ineffectual eyelid closing, drying out of eyelids and cornea, watery eyes, eyelid curling, cornea irritation, and the risk of an eye dislodging from the socket
• Dental and gum issues due to teeth crowding 
• Facial fold infections
• Reduced quality of life leading to a shortened life span; this is due to reduced exercise, sleeplessness, breathing difficulties, inflammation, and heart strain

The cause of health problems in brachycephalic breeds is directly related to the abnormal head and facial formations that occur due to the desired characteristics for the breed. Brachycephalic dogs are bred by humans to look a certain way, but these characteristic features create physical abnormalities and obstructions. These features include:

• Shortened muzzles and noses that cause flattened or undersized breathing passages
• Shortened bones in the face causing alterations in soft tissue structures that can obstruct airways
• Compressed upper jaw causing soft tissue malformation and teeth crowding
• Elongated soft palate that obstructs the airway 
• Malformed nostrils, or stenotic snares, that can collapse during inhalation
• Everted laryngeal saccules, or sacs near the vocal chords that obstruct the trachea
• Narrowing of trachea, which can lead to collapse
• Laryngeal collapse or paralysis
• Shallow eye orbits causing eye problems, and a higher risk of eyes that can pop out of socket due to even minor trauma

Common brachycephalic breeds include:

• English Bulldog
• French Bulldog
• Pug
• Pekingese
• Boston Terrier
• Boxer
• Shih Tzu
• Lhasa Apso
• Cavalier King Charles Spaniel

Often, your veterinarian will discuss the health concerns inherent with owning a brachycephalic breed on your first visit, and may alert you to the symptoms you may see if the problems become severe. Health problems will be diagnosed based on the breed, symptoms present, and the results of examination. 

A physical examination can determine some of the characteristics of the physical abnormalities that can predispose your dog to physical problems, but more often, complete sedation is needed to fully examine the internal areas responsible. Because brachycephalic dogs have an increased risk of complications with anesthesia, your vet may order blood work to assess your dog’s ability to handle sedation. Under anesthesia, a definitive diagnosis of several defining characteristics that create breathing issues can be determined. Chest X-rays can also help to assess your dog’s airways and lung condition.

Many of the physical abnormalities responsible for airway obstructions can be surgically corrected, and can be recommended for your dog if he is experiencing extreme distress, or is facing a life-threatening obstruction. This can include soft palate shortening through resection, removal of the laryngeal saccules, and correction of stenotic snares through removal of a wedge of tissue to allow better airflow. Early correction of these physical abnormalities can greatly improve breathing and can prevent worsening symptoms. Surgery can also be performed to correct curling eyelids. Your dog will be closely monitored after surgery, as swelling can occur. 

If your dog has mild symptoms, they may be managed without surgery through exercise control, and avoiding stress, heat, and humidity. Oxygen therapy and medications, including corticosteroids and nonsteroidal anti-inflammatories, can provide short term relief of symptoms. 

You can manage or prevent other health concerns through supportive care at home. Routinely brushing your dog’s teeth and providing an enzyme-rich diet can keep your dog’s mouth healthy. Clean facial folds with colloidal silver or witch hazel to prevent yeast from growing. You may need to provide lubrication for eyes that dry out. Obesity can make breathing more difficult in these dogs, so a weight loss program may be needed for those animals that carry too much weight.

If caught early enough, the prognosis for health problems in your brachycephalic dog can be good. Dogs under two years of age can breathe much easier and enjoy increased activity levels after surgery to correct physical abnormalities. Older dogs and those who have suffered a laryngeal collapse or other secondary problem have a fair to poor prognosis, through their quality of life can greatly improve with the right management techniques. 

If you have a brachycephalic dog, be sure to know his limits and control his exercise. Reduce any excitement or stress that can cause respiratory issues. Be sure to use a harness that does not tug on his neck, instead of a regular collar. Know that he may not be able to pant efficiently and is at a higher risk of heatstroke, so be sure to limit his exposure to hot temperatures, such as in a car. Dogs that need surgery to breathe should not be bred.