Brachycephalic Airway Syndrome

Laurie Anne Walden, DVM

This French bulldog has narrowed nostrils and prominent facial skin folds. Photo by Dan Blackburn on Unsplash.

The French bulldog is now the most popular dog in the United States, according to the American Kennel Club (which defines popularity by the number of purebred dog registrations). This result is no surprise; Frenchies have been rising in the popularity ranks for several years. But these little dogs have a host of potential health problems, just like other animals bred to have flat faces and short noses.
 
Brachycephalic Head Shape
Short-headed (brachycephalic) animals like English bulldogs, French bulldogs, pugs, and Persian cats have a shortened upper jaw and nose. The lower jaw is typically not shortened, so when they close their mouths, their lower incisor teeth might stick out in front of the upper incisors.
 
Brachycephaly affects only the bones, not the soft tissues (skin, tongue, soft palate, and so forth), so brachycephalic animals have too much soft tissue for their face size. This is why brachycephalic animals have skin folds between their nose and eyes. They have the skin to cover a nose that just isn’t there.
 
Respiratory Problems
In a brachycephalic animal, the soft tissues inside the mouth and throat are crammed into an upper jaw that’s too short to hold them. All of this excess tissue blocks the airway, causing a cascade of problems related to the increased effort of breathing.
 
The term brachycephalic airway syndrome describes problems caused by anatomic abnormalities that are common in brachycephalic animals. These abnormalities include narrowed nostrils, an elongated soft palate, and everted laryngeal saccules (tissue near the vocal cords that is pulled into the airway because of labored breathing over time). Brachycephalic animals might also have an enlarged tongue. Some have an abnormally narrow trachea, which increases the work of breathing and the risk of problems during anesthesia.
 
Other Problems
Brachycephalic animals are more likely than others to have heat stress. Their relatively shallow eye sockets and large eyelid openings increase their chance of developing corneal ulcers, dry eye, and other eye problems. Infections can develop between skin folds. Some brachycephalic animals have digestive tract problems like chronic vomiting, possibly related to gastric reflux caused by chronic labored breathing. They usually have crowded or malpositioned teeth. Natural birth is not possible for some brachycephalic dogs because the mom’s pelvis is too narrow for the puppies’ heads. Some breeds—including French bulldogs—usually require cesarean (surgical) delivery.
 
Signs
If you have a brachycephalic pet, watch for these signs of trouble:

• Snorting, snoring, or noisy breathing
• Intolerance to exercise
• Panting excessively, especially in warm weather
• Tongue or gums turning blue or purple—a medical emergency (lack of oxygen)
• Fainting or collapse
• Red eyes, squinting, or discharge from the eyes
• Moisture, discharge, redness, or odor from skin folds

 
Treatment
Anatomic problems like narrowed nostrils, elongated soft palate, and everted laryngeal saccules can be corrected with surgery. You can see photos of these problems and more information about surgery on the American College of Veterinary Surgeons website: https://www.acvs.org/small-animal/brachycephalic-syndrome.
 
One “treatment” for brachycephalic airway syndrome is to stop breeding dogs for extreme face shape. If you’re thinking of getting a French bulldog or another brachycephalic pet, reward breeders who breed for good health: choose a dog with round (not slit-like) nostrils, minimal or no skin folds near the eyes, and the ability to run, play, and sleep while breathing freely without snorting or gagging.
 
Image source: Dan Blackburn on Unsplash

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