Airway Disease

Airway Disease

Airway disease can severely compromises the ability of a dog to inhale, absorb oxygen and exhale.

    All Brachycephalic Breeds of Dog, obviously, have a shorter snout than other breeds, thus this anatomical characteristic has much higher incidence for more serious respiratory complications.

  When a dog inhales, the air is cooled by their snout, before it reaches their lungs. The ‘alveoli’ are the air sacs located in the lungs, which are responsible to grab the air and absorb the oxygen, thus transferring the oxygen absorbed into the bloodstream.  Hot air causes the alveoli to close and struggle to open to grab the air, and then less oxygen is absorbed into the bloodstream. As the oxygen absorption (saturation) decreases, the CO2 (Carbon Dioxide) increases. This is because refreshed (new) oxygen isn’t pushing the ‘CO2 saturated’ blood,  out of the bloodstream.   A dog breathing high levels of CO2 (over 60%) for and extended amount of time (usually 15 minutes), will become cyanotic (blue) and eventually the dog will stop breathing. In this situation, the dogs brain is not longer functioning and the dog will die.

   Therefore, the air the Brachycephalic dog inhales, is not getting cooled down before the air gets into their lungs. Thus, by inhaling hot air, makes it difficult for the alveoli to absorb oxygen. This is why Brachycephalic Breeds can not tolerate hot weather, and high humidity. The breathing of hot air also continues to increase the body temperature of the dog. The dog can no longer cool-off by panting, and their tongue continues to hang out more and more. A normal dog temperature is between 99 and 100, but in extreme heat, the dogs temperature can reach dangerous levels, anything over 104 is an emergency! This high temperature leads to Heat Stroke.

    Airway Disease consists of 4 Components: (1) Stenotic Nares (2) Elongated Soft Palate (3) Laryngeal Saccules (4) Collapsing Trachea

Brachycephalic Breeds of Dog


  There are many breeds of dog with Brachycephalic syndrome. ‘Brachy’ means ‘short’ and Cephalic pertains to ‘head’, this Brachycephalic dog breeds had a short head. Due to their abnormal skull, several compromising respiratory factors are evident, which may cause breathing difficulties and and may lead to a shorten their life span.

   Brachycephalic breeds include small and large dogs, however, the severity of their anatomy varies, when inspecting each individual dog.

   Most Brachycephalic Breeds of Dog are the very loved small breeds in the AKC Toy and AKC Non-Sporting Group, these include the Pekingese, Shih Tzu, Boston Terriers, Pugs, English Bulldogs, Affenpinscher, Brussels Griffon, English Toy Spaniel,  Japanese Chin, and the French Bulldog. Large Brachycephalic Breeds of Dog are in the AKC Working Group include the Boxer, Bullmastiff, Dogue de Bordeaux (French Mastiff), Neapolitan Mastiff,  

You will notice that there are no Brachycephalic Breeds in the Sporting Group, Hound Group, Terrier Group, Herding Group and Miscellaneous Group.


   Brachycephalic Dog Breeds may also have Stenotic Nares. ‘Stenotic’ means narrowing and ‘Nares” means nostrils. Stenotic Nares compromise the amount of air coming into the nasal passageway and into the trachea. There are varying degrees of stenosis in each individual dog. Some nares are so stenotic that puppies turn blue (cyanotic)  when they try to sleep, it’s very sad to watch.

  Stenotic Nares often requires minor cosmetic surgery, and is usually done when the dog is spayed or neutered. Nose Clips, as it is called, is done by removing a small triangular piece of the nostril and sewing the remainder back together with dissolvable sutures. Some breeders claim that Nasal Clipping causes unsightly scar tissue. But I disagree, after doing hundreds of Nasal Clips,  I have found no validity in their claim. If it comes down to it, should your dog be able to breathe? Or is the appearance of the nose more important? If there is any question if this procedure should be done at all, it should be done for the sake of your dog. Just be sure that your veterinarian has done this procedure before with high success.  

  The occurrence of stenotic nares is hereditary and can be avoided by not breeding dogs with this airway disease. Most reputable breeders have stenotic nares fixed as soon as possible, often as young as a few weeks old. However, many reputable breeders have eliminated this problem in their breeding stock.

   Several of my personal dogs (not breeding stock) have had Nose Clips. My Pekingese, Elsa, had the procedure when she was 6 months old. Her scars are totally undetectable and she is beautiful. Another dog, Bello, had his Nose Clips at age 7 months, but the surgeon used the Co2 Laser back in 2004. Unfortunately, his nasal tissue grew back,  and the surgeon told me that it was impossible. Only now we know (2010) that the use of the CO2 laser for Nasal Clips is discouraged. It has been proven that this technique allows the nasal skin to grow back to it’s original shape.  

   The dogs in my breeding program HAVE NOT had their nares altered in any way. They all have very open nares, which they will pass onto their puppies. I do not and will not breed any Pekingese (or other breed) that has Stenotic Nares.

 Brachycephalic Dog Breeds commonly have an elongated soft palate, which makes breathing difficult by obstructing the airway (larynx). The soft palate is positioned directly in front of the trachea, and if elongated, it hangs down and flaps back and forth as the dog breaths. Thus, causing difficulty getting the air into the trachea. Most dogs with an elongated soft palate snore loudly.

   Elongated Soft Palates can be surgically repaired as early as eight weeks of age. The palate is simply trimmed with a CO2 laser and the dog recovers quickly with no adverse side effects. The dog instantly breathes better. If the soft palate is done before the dog reaches the age of one year old, you will not endanger the health of the Laryngeal Saccules, which are located lower in the throat.

   If the elongated soft palate is left unattended and unrepaired, forced breathing remains for years. After years of forced, heavy breathing, extreme pressure has been placed on the Laryngeal Saccules. These Laryngeal Saccules then become enlarged or twisted (Everted) by the force of the dog’s breathing, thus, becoming an additional obstruction to the airway. Enlarged Laryngeal Saccules are located on each side of the larynx, and may close more than 60% of the dog’s airway.

   The Brachycephalic dog may encounter progressively worse breathing problems as they age, usually over 4 years of age. After years of difficult, labored and forced breathing, the dog may no longer want to walk long distances or have any desire to be active. This is most likely due to their airway being severely compromised. Unfortunately, many times this goes unnoticed by dog owners until the dog goes into Heat Stroke and or collapses.

   This is a medical emergency and if not treated immediately, can and will be fatal. At this point, surgical repair of the Soft Palate and removal of the Laryngeal Saccules is eminent.

1. Stenotic Nares

2. Elongated Soft Palate  &   3. Laryngeal Saccules

Soft Palate not obstructing Epiglottis.

Normal Soft Palate

CO2 Laser

4. Collapsing Trachea

Collapsing Trachea is a chronic, progressive disease of the trachea (or windpipe). The Trachea is a flexible tube that is made up of C-shaped rings of cartilage, which keep the airway open so the dog can breathe. (Diagram A)

    In some dogs, these rings become weak and begin to flatten out, thus ‘collapsing’. The collapsing tracheal rings can extend all the way down the the bronchi, the tubes that connect to the lungs, which severely compromises the dogs’ ability to breathe.

     Dogs will cough (or honk) when their trachea collapses, which can occur when the dog is picked-up, if they get excited, if they exercise or if their collar is pulled or tugged.

     Radiographs of a dog’s chest reveal trachea stenosis. (Diagram B) The progression of tracheal collapse can cause Heart Disease from the strain of breathing.

     Medical management is helpful for 70% of dogs with mild tracheal collapse and includes weight management because overweight dogs have extreme pressure exerted on their breathing mechanisms. Cough suppressants, antispasmodics, bronchiodilators and sedatives are used to break the cycle of coughing, which in itself continues irritates and aggravate the trachea. Some dogs develop infections and are treated with antibiotics. Owners are urged to use a harness instead of a collar and keep your dog out of polluted areas, such as fireplace and cigarette smoke.

    Some dogs do not respond to medical management, and require surgery to implant a ‘Stent’ (spring-like device) to keep the airway open. However, potential complications from surgery include coughing, bleeding, irritation and possible a paralyzed larynx.

     Certain breeds of dog are prone to a Collapsing Trachea, included but not limited to are Yorkshire Terriers, Pomeranians, Poodles, Chihuahuas.  

Head of  Dog

Tracheal Stenosis or Collapse

Bronchioles lead to lungs.

Tracheal Stent

Tracheal Stent In Place

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Diagram A

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Airway Disease

This poor Pug, he needs Nasal Clips!

This triangular piece of nasal tissue is removed.

Canine Rhinoplasty

After Surgery

Triangular piece missing both nostrils.

Before Surgery

Chest Radiograph

Very Stenotic Area of Trachea

Diagram B

The Elongated Soft Palate is held with two sutures and trimmed with a Co2 Laser.

Elongated Soft Palate covers Epiglottis

Epiglotis - leads to Trachea (airway)

Soft Palate


Everted Laryngeal Saccules

Tongue Depressor holding down the tongue and Epiglottis.


Hyoid Apparatus


Cervical Vertebrae