Brachycephalic Airway Syndrome in Pugs

You are not alone if you have ever heard your Pug snorting or even snoring at night. These breathing issues are common to the Pug breed, but Pugs are not the only dogs that experience these classic, loud breathing noises.

This relatively common condition is called Brachycephalic airway syndrome. You may also hear it called a brachycephalic respiratory syndrome.

It is a syndrome because it is a collection of symptoms called by specific upper airway abnormalities affecting brachycephalic dogs. Brachycephalic dogs are those breeds that tend to have short skulls, resulting in the face and nose showing a pushed-in appearance, even flat in some breeds. Pugs are not the only brachycephalic breed. Any dog that has a very short nose falls into this category, including Pekingese, French Bulldogs, Shih Tzu, and Boston Terriers, to name a few. Even some cat breeds suffer from breathing problems.

Brachycephalic syndrome affects dogs (and cats) differently, and symptoms can range from mild to severe.

What are Some Anatomical Abnormalities Associated with Brachycephalic Airway Syndrome?

Six issues have been associated with this condition.

  • Stenotic nares: “Stenotic” refers to constriction, and “nares” is another name for nostrils. Dogs with stenotic nares have small nostrils making airflow difficult, and this condition is easily seen even in young puppies.
  • Extended nasopharyngeal turbinate is a less obvious problem that cannot be seen without anesthesizing the dog. Nasopharyngeal turbinates are ridges of bone that function to humidify and warm air that is inhaled. If these bone ridges extend into the pharynx, it can cause obstruction of air.
  • Elongated soft palate: The soft part of the roof of the mouth is called the soft palate. When it is extended, the excess portion partially blocks the trachea entrance.
  • Laryngeal collapse: The larynx is the part of the throat often called the voice box. Laryngeal collapse is caused by chronic stress on the cartilage of the larynx, causing it to restrict airflow.
  • Everted laryngeal saccules: These are tiny sacs inside the larynx. When they are everted, they get sucked into the airway further, causing even more airflow obstruction.
  • Hypoplastic trachea: Hypoplastic refers to an undeveloped organ, so a hypoplastic trachea refers to a trachea or windpipe smaller than usual.

What are the Symptoms of Brachycephalic Syndrome?

When it is difficult to breathe, dogs compensate in several ways. You will notice noisy breathing, especially when exercising, snorting, and even snoring at night.

  • Labored breathing
  • Gagging when trying to swallow
  • Dogs that are more severely affected may tire quickly or even collapse after exercise.
  • Coughing, gagging, retching, and even vomiting have been reported.
  • Some dogs may show signs of cyanosis (blue tongue and gums)
  • Symptoms are usually worse in hot or humid weather because dogs use panting to cool their bodies, and panting is more difficult for these dogs.
  • Over time, symptoms can worsen and affect other body organs, including the heart.

Who Gets Brachycephalic Syndrome?

Dogs with flat faces are the most likely to encounter symptoms associated with the syndrome. Both males and females are equally susceptible. Owners typically notice these symptoms early on and contact a veterinarian for answers. Most dogs are diagnosed by the time they are four years old.

How is Brachycephalic Airway Syndrome Diagnosed?

Pug owners first notice symptoms and may see signs of stenotic nares. Still, a veterinarian must diagnose based on clinical signs, x-rays, and examination of the mouth’s structure under anesthesia. Surgical correction may also be done at the same time.
Blood work is often ordered if procedures involve anesthesia because dogs with this syndrome do not always do well with anesthesia.

Are There Any Treatment Options for this Syndrome?

A wide range of options is available for Pugs with Brachycephalic Airway Syndrome, depending on the severity of the problem. For mildly affected dogs, restricting exercise, keeping the dog cool, maintaining an ideal weight, and avoiding stress.

There are additional options when dogs do not respond to the simple measures mentioned above. A veterinarian may opt to treat the symptoms or suggest surgery. Corticosteroids, nonsteroidal anti-inflammatory drugs, and oxygen may relieve some symptoms, but they do not correct the underlying anatomical abnormalities.

Surgery is usually indicated when the abnormalities are severe enough to interfere with breathing. Some vets do this themselves, but many refer to specialists, making the surgery costly.

For puppies with stenotic nares, surgery is often performed early, as young as four to six months. Some vets prefer to correct the stenotic nares at the same time they perform a spay or neuther operation so that the dog does not need to undergo anesthesia more than necessary.

Prognosis of this Syndrome

For very mild symptoms, follow the advice below. The prognosis is good. Surgery has an excellent long-term outcome for dogs with severe symptoms, but monitoring and being mindful of signs over time is still required. The younger the dog when surgery is performed, the better the outcome. The prognosis for a full recovery is good if laryngeal collapse has not occurred or right-sided heart failure.

Is there any other advice?

Since dogs do not acquire these problems but are born with them, owners need to know that a genetic component is involved. When buying a pug from a breeder, it is always a good idea to ask about the health of the puppy’s parents.

Once in the home, puppy parents can take some sensible measures to keep their Pug safe.

  • Puppies and adult dogs should always wear loose harnesses around the neck. Training should always be done with a harness rather than a regular collar. A neck collar can put pressure on the neck and trachea, leading to tracheal collapse. A collar should only be used to hold tags such as Rabies, identification or microchip tags.
  • Dogs that are severe enough to require surgery to correct abnormalities should not be used for breeding.
  • Flying with a brachycephalic dog can cause additional stress. Never allow these dogs to fly in cargo bays; instead, ensure they can fly in the cabin. A road trip with your beloved Pug is far safer than flying.
  • Talk to your vet about surgical interventions and ask for advice about anesthesia.
  • Keep your Pug in a cool air-conditioned area in hot, humid weather
  • Limit exercise
  • Maintain a healthy weight.

The Pug is My First Choice of Dog Breed. Should I worry?

Pugs are generally a healthy breed and live a long life. They do have some health concerns to be aware of before taking the plunge into pet parenthood. Brachycephalic syndrome is a concern for any pet parent who has a dog with a “smushed-in” flat face, but it need not be a deciding factor. The best advice is to find a high-quality, reputable breeder who is familiar with the breed’s health problems and has made plans to find healthy breeding dogs that will produce healthy puppies.


Brachycephalic Airway Syndrome is common in dog breeds with flat faces including French Bulldogs, English Bulldogs, Pekingese, Shih Tzu, Pugs, and Boston Terriers. Symptoms can range from mild snorting and snoring to more severe symptoms that affect other organs including the heart.

There are common-sense measures that pet parents can take to protect their flat-faced dog, but surgery is also an option for dogs with severe symptoms. The prognosis is good for dogs who are treated early and most go on to live a long healthy life.

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