Some breeds of dogs and cats are prone to difficult, obstructive breathing because of the shape of their head, nose and upper airways. The most common dogs affected are the "brachycephalic" breeds. Brachycephalic means "short-headed." Some common brachycephalic dog breeds include the English bulldog, French bulldog, Pug, Pekingese, and Boston terrier. These dogs have been bred to have relatively short muzzles and noses and, because of this, the upper airways are compressed and there is obstruction of airflow through the upper airways. The condition worsens with age and may lead to secondary changes.

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 Dogs with brachycephalic airway syndrome usually have a history of noisy breathing, snoring and  poor exercise tolerance which worsens in hot, humid weather. Some dogs will also vomit or gag when swallowing. Episodes of cyanosis (blue tongue and gums from lack of oxygen) and collapse can occur at times of excitement or stress in some dogs. Being overweight tends to worsen the problems.

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The primary problems seen in brachycephalic dogs include:

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• Stenotic nares - where the nostrils are too small to allow adequate passage of air making breathing through the nose difficult.

• Elongated soft palate - where the soft palate is too long. In these cases the soft palate is excessively long allowing it to sit within the opening of the trachea (windpipe) and thus obstructs normal airflow. The elongated soft palate creates turbulent airflow resulting in the increased respiratory noise we hear in brachycephalic dogs, including snoring

• Everted or swollen laryngeal saccules - These saccules normally sit either side of the floor of the larynx just in front of the vocal folds / chords. In brachycephalic dogs the increased effort of breathing may result in the saccules becoming swollen resulting in obstruction of airflow. Swollen laryngeal saccules is the first stage of collapse of the larynx a very serious condition.

• Tracheal hypoplasia - where the trachea (windpipe) is too small. This condition cannot be treated however addressing the other airway issues may be of benefit.

• Tonsillar hyperplasia or enlarged tonsils. This is common in brachycephalic breeds due to chronic inflammation. This is typically assessed with each individual and tonsil removal is performed if required

•  Overgrowth of the nasal turbinate bones - this occurs in some cases and may require additional surgery if breathing is not improved by correction of the above problems. Nasal CT and referral surgery is required to address this issue.

• Regurgitation- is common in affected dogs due to negative airway pressures promoting stomach acid reflux. Regurgitation of food, white froth or bile is often the primary problem noted.

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Generally, if the primary problems are addressed at an early age (ideally less than 2 years old), animals usually require less complicated surgical procedures, and long term outcomes are improved. Thus, early intervention is strongly recommended. For this reason we like to assess and address any underlying issues at early as 6 months of age (ideally this assessment will be performed at desexing). A full anaesthetic is required to assess the severity of the brachycephalic airway syndrome.