Why do pugs have breathing problems?

Because pugs’ skulls and muzzles are compact, their throats and breathing passages are frequently undersized or flattened, obstructing their airflow, and making breathing difficult. But pugs are not the only breeds gasping for air, other brachycephalic breeds include:

• Bulldogs (French and English)
• Boxers
• Boston terriers
• Pekingese
• Lhasa apsos
• Shih tzus
• Bullmastiffs

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What is brachycephalic airway syndrome?

Brachycephalic airway syndrome (BAS), brachycephalic syndrome (BS), and brachycephalic obstructive airway syndrome (BOAS) describe anatomic abnormalities that cause upper airway dysfunction in brachycephalic breeds. Most brachycephalic breeds are born with stenotic nares (i.e., abnormally narrow or small nostrils), a hypoplastic trachea, or both, which commonly lead to soft palate elongation, laryngeal saccule eversion, and—ultimately—laryngeal collapse.

• Stenotic nares —  Many pugs (50%) have stenotic nares, which restrict their airflow, causing noisy inhalation and snoring, and making breathing difficult during physical activity. 
• Elongated soft palate — Pugs may have an elongated soft palate at the back of their throat that partially blocks the trachea (i.e., windpipe) entrance and inhibits breathing. 
• Everted laryngeal saccules — A pug’s laryngeal saccules are located above their vocal cords. When these saccules become everted (i.e., turned inside out), they partially block the trachea entrance, making breathing difficult. Laryngeal saccule eversion is the first stage of laryngeal collapse, which can be fatal if not treated early.
• Laryngeal collapse — Laryngeal collapse occurs after anatomic upper airway abnormalities have chronically stressed the larynx’s (i.e., voice box’s) cartilage. Eventually, the larynx cannot open as wide as needed, causing additional airflow restriction.
• Hypoplastic trachea — Pugs have hypoplastic (i.e., narrow) tracheas, and they commonly suffer trachea degeneration as the cartilage rings weaken, and may eventually collapse. 

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What are brachycephalic airway syndrome signs in pugs?

BAS may affect all pugs because of their severe brachycephalic anatomic abnormalities, but the signs’ severity varies. Generally, a pug who has several upper airway anatomic abnormalities will have more severe signs. Common BAS signs include:

• Mouth breathing
• Snoring
• Disrupted sleep
• Cough
• Heavy panting
• Respiratory noise
• Rapid breathing
• Shortness of breath
• Gagging and regurgitating
• Exercise intolerance

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How are pugs treated for brachycephalic airway syndrome?

Although your pug may have anatomic upper airway abnormalities, they can remain healthy and enjoy a good quality of life. You can help your pug remain comfortable and avoid a respiratory emergency by monitoring them closely.

• Weight loss — Maintain your pug’s weight within a healthy range. Help your pug avoid obesity, as this condition worsens BAS. 
• Modified exercise — Although exercise is always important, prevent your pug from overheating and experiencing breathing issues by avoiding intense activity levels or long exercise sessions. In addition, take frequent breaks, and carefully monitor your pug for labored breathing and exhaustion signs. 
• Heat avoidance — Brachycephalic breeds are ineffective panters, and susceptible to overheating. Run your home’s air conditioner during hot weather and avoid running your furnace too warm during the winter. When the temperature is hot, limit your pug’s outdoor time and avoid exercising them strenuously.
• Medication — Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and oxygen therapy may provide your pug short-term relief for airway inflammation or respiratory distress, but medications do not correct anatomic upper airway abnormalities.
• Surgery — Surgery is often the best treatment for correcting anatomic upper airway abnormalities that interfere with pugs’ breathing. Surgery options include:

• Stenotic nares surgery — Stenotic nares can be treated by removing a tissue wedge from your pug’s nostrils, allowing improved airflow. 
• Elongated soft palate surgery — An elongated soft palate can be surgically shortened to a more normal length. 
• Everted laryngeal saccules surgery — Everted laryngeal saccules can be surgically removed to eliminate laryngeal obstruction.

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Understanding your pug’s unique health risks can help you better support their health care needs and make informed treatment decisions. At Dr. Treat, we believe knowledge is power. With genetic breed testing—available at our clinic—we can analyze your pet’s DNA for more than 100 genetic diseases and breed-related trait markers, taking preventive measures to shape your pet’s future health and wellbeing. Become a member today and breathe a little easier, knowing your pug is in good hands. 

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