Symptoms of tracheal hypoplasia can occur in puppies at any age, though most puppies present with labored breathing and a cough between 5- 7 months. Tracheal hypoplasia is a congenital condition that most commonly afflicts young Brachycephalic or “short-nosed” breeds such as Bulldogs, Shih Tzus, and Boston Terriers. Due to breed-specific features, such as short, boxy skulls and pushed-in noses, Brachycephalic puppies are genetically inclined toward upper respiratory symptoms like wheezing, coughing, and pneumonia. An aberrant trachea further compounds breathing difficulty and presents an even greater challenge to the dog, veterinarians, and pet owners.  

Prognosis of a puppy with tracheal hypoplasia mostly depends upon the degree of tracheal narrowing, the severity of clinical signs, as well as the presence of other conditions. Careful lifestyle management, especially maintaining a healthy weight, appears to positively impact the puppy’s outcome. Dogs with exceptionally narrowed airways and breathing difficulties should be kept in a calm, low-stress environment, in cool temperatures (to limit overheating and excess panting) and handled carefully to reduce stress and anxiety. The condition is exacerbated by exercise, so puppies must be monitored for over activity. 

In the best possible scenario, some puppies “outgrow” the condition when normal development lessens the severity of the narrowed structure.

Key to the upper respiratory system, the trachea (windpipe) is the tube that extends from just below the larynx to the bronchi, and serves to express air to and from the lungs. Because of the significant role the trachea plays in respiration, abnormalities that might occur during development pose potentially life-threatening consequences to otherwise healthy animals. One such disorder, tracheal hypoplasia, occurs in puppies when a fusing or overlap of the cartilaginous rings that form the tracheal structure creates an abnormally narrow windpipe that obstructs air flow and breathing.

The diagnosis for hypoplastic trachea is typically made based on a combination of owner-reported symptoms, the presentation of clinical symptoms such as wheezing and cough, the pet’s history, breed considerations and the overall physical examination. Radiographic testing (x-ray) and evaluation by a radiologist is required to confirm the tracheal size, diameter, and extent of narrowing. Surgical exploration is generally not recommended for a dog with a potentially compromised airway due to risks associated with anesthesia. 

Hypoplastic trachea is most commonly seen by veterinarians in young brachycephalic “short-nosed” breeds such as Boxer, Bull Mastiff, Shih Tzu, Lhasa Apso, Pug, Yorkshire Terrier, Boston Terrier, Pekingese, and most commonly, Bulldog. In these breeds, the condition could be isolated, or else is one component of a brachycephalic syndrome, a condition that can cause severe respiratory distress, rapid escalation of symptoms and sometimes crisis.  Four different anatomical abnormalities contribute to the disease, including an elongated soft palate, stenotic nares, a hypoplastic trachea, and everted laryngeal saccules. Symptoms increase with age and left unmanaged, can escalate to respiratory crisis or death.

There are no defined treatments for tracheal hypoplasia in puppies. Individual treatment plans are developed per the severity of the tracheal narrowing as well as the presence of other health complications. Tracheal hypoplasia can be a component of brachycephalic syndrome and become associated with other upper airway insults such as stenotic nares, elongated soft palate and everted laryngeal saccules. When comorbid conditions such as cardiac or pulmonary disease are involved, treatment becomes more complicated.  Puppies with slight to moderate narrowing of the trachea may be asymptomatic and not require treatment.  In most cases, these puppies can be managed medically by the veterinarian.  

Given the unique structure of the flat face and short nose of brachycephalic dogs, the incidence of respiratory infections increases. Antibiotics may be used to treat bacterial infections such as bronchopneumonia.  Medications such as inhaled medications (bronchodilators) and oral steroids are sometimes used to dilate the airway and minimize inflammation.  

Surgical intervention may not always be an appropriate treatment due to the additional stress that anesthesia places on the already compromised airway. However, in life-threatening cases or when quality of life is poor, surgery to expand segments of, or the entire trachea or nasal openings and canals may be elected.

Puppies born with a narrowed or obstructed airway may simply outgrow the condition, making further treatment unnecessary. Conversely, in the most severe cases, particularly those with accompanying cardiac defects, euthanasia may be the most humane option.

Puppies born with hypoplastic trachea will require careful lifestyle management to augment both physical health and quality of life. Pet owners must be observant and watch for any changes in breathing sounds or patterns. Signs of infection, frequent vomiting, eating or drinking changes and increased lethargy must be noted and immediately brought to the veterinarian’s attention. Puppies and adult dogs with tracheal hypoplasia are always at risk of respiratory attack and are especially susceptible to infection. Cool, comfortable temperatures, and calm, low-stress environments are optimal.

Dogs should also have follow-up veterinary care and occasional imaging to monitor the trachea. If prescribed, any treatments such as oral medication or bronchodilator should be maintained.