Tracheal Collapse in Dogs

Laurie Anne Walden, DVM

Photo by Sophie Shankey on Unsplash

Tracheal collapse causes a chronic dry cough that sounds similar to a goose honk. The disease tends to get worse with time. Tracheal collapse can’t be cured, but for most patients, medical treatment reduces the severity of the cough. In the most serious cases, tracheal collapse interferes with breathing and requires emergency care.
 
Tracheal collapse can affect dogs of any breed but is most common in small-breed dogs like Yorkshire terriers and Pomeranians. It’s rare in cats.
 
Cause
The trachea (windpipe) is a tube held open by rings of cartilage. In animals with tracheal collapse, the cartilage rings soften and become weakened over time. The cartilage rings lose their ability to hold the trachea open and the trachea flattens during breathing or coughing, blocking the flow of air.
 
The severity of the signs depends on the percentage of airway that’s blocked. The signs also partly depend on the location of the affected section of trachea: outside the rib cage (in the neck) versus within the rib cage.
 
In dogs with tracheal collapse, coughing is made worse by pressure on the neck, excess weight, stress, excitement, exercise, respiratory irritants like smoke, and respiratory infections. Some dogs with tracheal collapse also have abnormalities of the larynx and the bronchi (airways inside the lungs). Chronic coughing causes airway inflammation, which in turn leads to more coughing.
 
Tracheal collapse and heart disease are both common in middle-aged and older small-breed dogs, so many dogs have both diseases at the same time. Both diseases cause coughing and exercise intolerance. Figuring out which disease is most responsible for the cough can be a bit of a diagnostic challenge.
 
Signs

• Harsh, dry, honking cough
• (Possibly) a cough that gets worse with pressure on the neck or with exercise
• Wheezing
• Exercise intolerance
• Blue or purple gums caused by low oxygen level (medical emergency)
• Collapse or fainting (medical emergency)

 
Diagnosis
Tracheal collapse is suspected on the basis of the patient’s history, the sound of the cough, and physical examination findings. A definite diagnosis is made with imaging studies. Radiographs (x-ray images) sometimes show a collapsed trachea and are also used to evaluate heart size and the appearance of the lungs. In many dogs the trachea collapses only on inhalation or only on exhalation, so fluoroscopy—an x-ray “movie”—can reveal collapse that doesn’t appear on radiographs. Tracheoscopy is examination of the inside of the trachea and bronchi with a fiber optic camera in an endoscopy tube. An advantage of tracheoscopy is that it allows samples from inside the trachea to be collected for laboratory analysis; a disadvantage is that it requires general anesthesia.
 
Dogs with tracheal collapse might have bloodwork to assess their overall condition, especially if they are older or have concerning clinical signs. Because the signs of tracheal collapse and heart disease overlap, dogs with suspected or known heart disease also benefit from echocardiography to evaluate heart function.
 
Treatment
Tracheal collapse isn’t curable, so medical treatment needs to continue for life. Medications chosen for an individual patient might include cough suppressants to break the cough cycle, corticosteroids to reduce airway inflammation, bronchodilators, and antianxiety medications or sedatives to reduce stress. The choice of medication can change over time as the dog’s disease progresses.
 
Nonmedical management is crucial for dogs with tracheal collapse and includes the following:

• Weight management
• Use of harness instead of leash and collar
• Elimination of respiratory irritants like smoke and scented air fresheners

 
Surgical procedures like tracheal stent placement are available for dogs with severe signs. However, surgical options don’t cure the underlying tracheal problem and might not eliminate the cough.
 
Image source: https://unsplash.com/photos/a-small-dog-standing-under-a-wooden-bench-HSs4t4TWPFg

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