Brachycephalic Airway Syndrome in Dogs

By Veronica Higgs, DVM on Jan. 6, 2023

What Is Brachycephalic Airway Syndrome in Dogs?

Brachycephalic is a term that refers to dog breeds with shortened snouts and flat faces. The term brachycephalic comes from the Greek words brachy, meaning short, and cephalic, meaning head.

Brachycephalic airway syndrome refers to a specific combination of abnormalities affecting a dog’s airway and breathing, resulting from selectively breeding for this appearance. Their unique smooshed face is a result of shortened skull, facial, and nasal bones. This structural shortening of the face also results in anatomical changes to their throat and airways, creating brachycephalic airway syndrome.

Specifically, the condition refers to the combination of three functional abnormalities:

Stenotic nares: Referring to narrow nostrils or small nostril openings. This results in a decreased ability to breathe through the nose and restricted airflow, which leads to increased panting and a higher risk of overheating.
Elongated soft palate: The soft palate is the part of the roof of the mouth made up of tissue that separates the nasal passage from the oral cavity. Given brachycephalic dogs’ shorter snout, the soft palate is often too long for the length of their mouth. The excess flaps into the throat, causing snoring sounds and blocking airflow into the windpipe and lungs.
Everted laryngeal saccules: In normal anatomy, there are two small pockets (saccules) in the back of the throat. In brachycephalic dogs, there is an increased effort to breathe due to the stenotic nares and elongated soft palate. This increased effort to breathe can cause the saccules to turn inside out and further block the airway.

Additional airway-related conditions to brachycephalic airway syndrome include:

Hypoplastic trachea: This means the trachea, or windpipe, is congenitally smaller in diameter than normal. This can make it harder for dogs to breathe in enough air with each breath (like breathing through a straw).
Laryngeal collapse: The larynx, or voice box, can become damaged by chronic stress to the cartilage from working too hard to breathe. Laryngeal collapse leads to more blockage of the airway, and potentially trouble breathing.

Which dog breeds are considered brachycephalic?

Symptoms of Brachycephalic Airway Syndrome

Clinical signs are typically related to upper airway blockage due to the congenital anatomical conditions causing brachycephalic airway syndrome. Symptoms may range from mild to severe and include:

Noisy breathing
Snoring
Gagging or retching
Coughing
Trouble breathing or increased effort to breathe
Increased panting
Exercise intolerance (tire easily with exercise)
Distended abdomen or vomiting from swallowing too much air while working to breathe
Overheating
Pale or blue gums
Collapse

Causes of Brachycephalic Airway Syndrome

Brachycephalic airway syndrome is a genetic condition resulting from intentionally breeding dogs for a cosmetic appearance of short snouts with flat faces. Their anatomically shortened heads lead to structural changes to their throats and airways, which can cause trouble breathing and make these dogs prone to overheating.

How Veterinarians Diagnose Brachycephalic Airway Syndrome

Diagnosis will be largely based on the dog’s breed, clinical signs, and physical examination findings, such as stenotic nares (narrowed nostrils). A classic breathing noise characterized as a low-pitched, snoring-type sound called stertor may be noted in dogs with brachycephalic airway syndrome.

Your veterinarian may want to perform a sedated oral examination to evaluate for elongated soft palate and everted laryngeal saccules. An x-ray of the neck and chest may also visualize the trachea (windpipe) and assess the heart and lungs. A complete blood count, serum blood chemistry, and urinalysis will likely be recommended for a baseline evaluation.

Treatment of Brachycephalic Airway Syndrome

Medical management may be an option if clinical signs are mild or infrequent. Excessive weight worsens the symptoms, so medical management for brachycephalic airway syndrome includes weight loss if your dog is overweight or obese. Heat and humidity can also worsen clinical signs, so care should be taken to limit time outside during hot summer days. Excessive exercise can increase stress of breathing and may exacerbate brachycephalic airway syndrome.

If your dog is having trouble breathing while at the vet, they may utilize mild sedatives to help your dog calm down and breathe easier. Additional therapy may be initiated if appropriate, including steroids, oxygen, and cooling measures, all designed to alleviate acute respiratory distress. Medication may also be administered to address any gastrointestinal signs, such as vomiting.

Surgery may be considered if the structural abnormalities cause distress to your dog, become worse over time, or result in life-threatening trouble breathing from upper airway blockage. Life-threatening would be defined as more than one episode where your pet has had trouble breathing and needed medical assistance. Multiple procedures are usually required to alleviate the signs of brachycephalic airway syndrome, and include:

Stenotic nares resection: Surgically widening the nostrils.
Soft palate resection (staphylectomy): Surgical trimming of the soft palate to shorten the tissue.
Laryngeal saccule removal: Removing the everted saccules.

All three procedures can be performed at the same time, and this is typically most recommended. Most dogs with brachycephalic airway syndrome are diagnosed by 4 years old, but surgical correction can be performed as early as 4 months of age. Early diagnosis and surgical intervention may help reduce complications of chronic upper airway disease, such as developing laryngeal collapse. If you have a brachycephalic breed, discuss brachycephalic airway syndrome with your veterinarian, and if your dog is a possible candidate for surgery.

How Much Does Brachycephalic Airway Syndrome Surgery Cost?

The cost of surgery for brachycephalic airway syndrome can vary depending on many factors, including geographic location, how sick the dog is, and how extensive the procedure needs to be. However, if all three procedures are performed, pet parents can likely expect to paya total between $3,000 and $5,000.

Pet insurance may be a good idea to help offset anticipated costs and illnesses related to getting a new pup. However, when it comes to inherited and breed-related conditions (like brachycephalic airway syndrome), not all policies offer coverage if conditions are considered pre-existing. Make sure that any pet insurance policy you consider covers brachycephalic dogs and brachycephalic airway syndrome.

Recovery and Management of Brachycephalic Airway Syndrome

Dogs undergoing brachycephalic airway surgery are monitored carefully after surgery, as inflammation and bleeding are possible. Typically, they will remain hospitalized in a 24-hour ICU for 1-2 days of observation.

The prognosis is good for young dogs, and most pet parents see a significant improvement in their breathing and ability to exercise. However, prognosis may be more guarded in older dogs with a chronic history of trouble breathing, especially if they have started to develop laryngeal collapse. In cases of advanced laryngeal collapse, a tube may need to be inserted in the neck (permanent tracheostomy) to provide improvement in breathing.

For long-term management, it’s crucial to keep brachycephalic dogs lean and at an appropriate weight. Working with your vet on a weight goal and, if needed, a weight loss plan may be very beneficial. A harness collar is recommended to take pressure off the neck as seen with a traditional neck collar.

Extreme care should always be taken to ensure that brachycephalic dogs do not overheat. Minimal activity or time outside during hot and humid weather is recommended, and always have plenty of fresh water and access to shade.