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Bulldog or Pug with breathing issues

Brachycephalic Airway Syndrome (BOAS)

Dogs with shorter “smooshed” faces (bulldogs, frenchies, pugs, etc.) are called “Brachycephalic” (short-faced) breeds. While adorable, the shortened face in these dogs changes the airway anatomy to make normal breathing and airflow more difficult. 

How is a brachycephalic dog diagnosed?

  • Physical exam - A diagnosis of BOAS is able to be made on physical examination

  • Sedated airway exam - Sedation is required in order to evaluate the back of the throat to confirm diagnosis and determine the best surgical treatment plan

  • Chest X-rays - because BOAS patients are at a higher risk for developing aspiration pneumonia, chest x-rays are recommended to rule this out before pursuing anesthesia

  • Blood work - this information is used to develop the safest anesthesia and pain management plan for the patient

Stenotic nares - BOAS dog

How is a brachycephalic dog


The goal of surgery is to enlarge the airway in each problem area to make breathing less difficult and improve airflow to the lungs. We achieve this goal by performing surgery to reduce or eliminate unnecessary tissue in the airway.​


Stenotic Nares Correction


We correct the abnormally narrowed nostrils by surgically enlarging the openings to the size of a normal dog.  (See the photo inset). This procedure is called an Alarplasty and improves airflow through the nose so your pet doesn’t have to work as hard to breathe.


Elongated and Thickened Soft Palate Correction

The long and thickened palate is surgically corrected using a procedure called Folded Flap Palatoplasty, or Staphylectomy. These procedures remove excess tissue from the elongated soft palate to prevent excess tissue from being sucked into the windpipe (trachea).

Everted Laryngeal Saccules Correction


The weakened tissues of the larynx that collapse into the trachea (windpipe) are surgically removed with a procedure called Laryngeal Sacculectomy. Removal of this obstructive tissue further clears the windpipe (trachea) to improve airflow to the lungs.

Because of the physics of airflow during breathing, every bit of abnormal tissue removed from the airway leads to a profound improvement in airflow to the lungs.


The goal of medical management is to make lifestyle changes to avoid respiratory distress episodes and overheating. Whether surgery is performed or not, we recommend the following lifestyle changes to maximize your pet’s quality of life.

(continued below)


A shortened face is why brachycephalic dogs often have louder breathing (stertor), are less able to tolerate prolonged exercise and heat, snore at night,have disrupted sleep patterns, and sometimes regurgitate food and water. Depending on the severity of the abnormalities, these dogs are at a higher risk for collapse and death from inability to oxygenate (hypoxia), and from overheating.


Why is my dog breathing loudly?


There are four commonly found abnormalities in the anatomy of brachycephalic breeds that predispose them to BOAS:

  • Stenotic Nares (narrow nostril openings) - the opening of the nasal passages in brachycephalic dogs is abnormally narrow and collapses during inspiration. This blocks normal airflow from entering the nose without additional effort.

  • Elongated and Thickened Soft Palate - the soft tissue behind the hard roof of the mouth is too long relative to the shortened face of brachycephalic dogs, this long and thickened extra soft tissue is sucked into the windpipe and blocks the airway. You can hear the elongated soft palate fluttering and making snoring noises when breathing in these dogs, especially after activity.

  • Hypoplastic Trachea (abnormally narrow trachea) - the trachea of brachycephalic breeds is abnormally narrow, which adds to the overall breathing difficulty. Unfortunately this is the one abnormality which cannot be corrected.

  • Everted Laryngeal Saccules (early collapse/obstruction of the windpipe opening) - because of how hard brachycephalic dogs have to pull to bring air into their lungs, soft tissues of the airway can weaken and collapse into the path of airflow during breathing. 

Can my dog just live with this condition and still have a normal life?


Additional abnormalities may be present and develop as BOAS progresses with time. In addition to breathing problems, many brachycephalic dogs also have repeated episodes of regurgitation. Excessive regurgitation typically improves after surgical correction of the airway syndrome.


*If regurgitation persists after airway surgery, this may indicate the presence of a hiatal hernia (loosening of the ligaments that hold the stomach and esophagus in place) and may require additional treatment.

Weight Management


Brachycephalic dogs are not able to tolerate additional weight as well as other breeds. These dogs in particular should be kept as thin as possible to avoid excess fat around the throat and airway, as well as to prevent overheating. The top of the spine and ribs should be easily felt when petting those areas, if not, there is the presence of excess fat in these locations. Low fat diet and controlled exercise is the main way to encourage a healthy weight for your dog. Thin brachycephalic dogs are much less likely to have life-threatening respiratory distress episodes.



Use a harness instead of a neck collar when walking your pet, this will prevent additional pressure on the throat and airway when on leash.


Avoid Excess Heat


Dogs cannot sweat to cool down like people can. Their main way to control body temperature is through panting/breathing. Because brachycephalic dogs have difficulty breathing, they also have difficulty regulating their body temperature and are prone to extreme overheating. Brachycephalic dogs should avoid exercise and play outside during the hottest times of day. Monitor your pet closely when active for difficulty breathing and give them frequent breaks in a cool environment.


Reduce Stress


Stressful situations cause dogs to pant excessively and overheat. This can lead to episodes of difficult breathing in dogs with BOAS. If you know your dog gets stressed or over excited with visitors or storms, a light sedative can be given to help keep them calm during the excitement and prevent breathing issues. A sedative medication can be prescribed by your veterinarian if needed.


Avoid Respiratory Irritants


Anything with a strong smell can be irritating to the airway of dogs and can cause coughing and worsen breathing. This includes smoke, candles, incense, perfumes, and sprays. Keep in mind that dogs are much more sensitive to smells than humans are. Try to minimize your dog’s exposure to anything with a strong scent or which may be irritating to the airway.


For additional information about this condition, visit


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