A Veterinary Update: Brachycephalic Obstructive Airway Syndrome

Doukraan Bulldogs endorse Massey University Veterinary Hospital.  We had expressed our concerns regarding vets perception that 'all bulldogs are poorly bred' to Kat & Jon, and were thrilled with Kat and Jon's passion to help the breed, not judge it.  Doukraan Bulldogs have offered our Bulldogs and will be working with Massey's  (Kat & Jon) research, which will assist Massey's understanding of the breed and also offer us a new insight into our Bulldogs.  We encourage anyone with 'worries' or 'questions' to contact Kat or Jon at Massey University Veterinary Hospital NZ.

It is well known that English Bulldogs and other ‘short nosed’ breeds can have problems with the upper airway. This most commonly results in excessive breathing noise, exercise intolerance and overheating. Some people may feel that noisy breathing, snoring and an inability to exercise is ‘normal’ for these dogs; however this shouldn’t be the case.

In the last few years a lot of research has been focused on how to assess the severity of the syndrome in dogs and how best to treat it. Like many syndromes there are a lot of factors that influence the degree of clinical signs and there is also great variability between individuals.

Traditionally the syndrome has been described by stenotic nostrils (fig 1.), a long soft palate and a narrow trachea.  Recent studies have also shown other important factors including a thick soft palate (fig.2) and gastric reflux (heart burn).

Fig. 1: Stenotic (narrowed) nostrils

Fig. 2:

The difference in soft palate thickness between average and short nosed breeds

When we examine any brachycephalic breed we grade the severity of the breathing signs using the following guide (Poncet et al. 2005):

Similarly we grade any heart burn or vomiting with this guide:

After assessing both breathing and digestive signs we can then recommend treatment for the airway and/or heartburn if necessary.

Treating the airway:

We have found that just shortening the soft palate does not always fully resolve the problems the dog is having. A newer surgical technique has been designed to treat both the excessive length and thickness of the palate - the ‘folding flap palatoplasty’. This surgery is a little more difficult but by removing the thick portion of the palate helps to reduce even more of the obstruction and gives us better post-operative outcomes. At Massey we have been using this technique for the last five years and are really pleased with our results.

At the same time as this surgery we would also treat stenotic nostrils if necessary.

Treating reflux and vomiting:

If we have assessed a patient to have grade 2 or 3 digestive signs we will start treatment for reflux before any airway surgery. This would normally involve taking antacid medication for 2 weeks before surgery. We advise omeprazole (Losec) given once a day. The dose required depends on the dog’s weight and can be given each morning with breakfast. This reduces the amount of acid produced in the stomach and therefore reduced the irritation and feelings of heart burn.  A prescription from your vet would be needed to start this treatment.

Key Points

• Bulldogs, pugs and other short nosed breeds should be able to exercise normally and tolerate hot days.
• Airway problems can be made worse by concurrent reflux or heart burn.
• A new surgical procedure to treat the long and thick soft palate is giving great results and better quality of life.
• Treatment of reflux is easy and if often required at the time of airway treatment for best results.

At Massey we are very interested in this condition and love treating all our brachycephalic patients. When they are examined with us we ensure they remain relaxed and cool with special kennels and cooling bedding in the ICU. A full examination of their airway including xrays is always performed and then a plan made for the individual patient depending on the type and severity of the clinical signs.

We are also doing further research to study:

·       How to measure the airway without the need for sedation or anaesthesia.

·       Why the palate is so thick as well as long.

·       How gastric reflux affects the soft tissues of the throat.

Although we may take samples from the cases we see, no additional procedures or tests would be performed that are not already part of the normal diagnosis and treatment plan for each dog. Hopefully every dog we treat will help similar dogs in the future live happy and active lives.

As well as clinical cases we would also be interested in examining dogs who are able to exercise well and do not have any airway problems so we can start to identify the important differences between normal and clinically affected dogs.

If you have any questions or are interested in discussing your dog with us please contact Kat or Jon at Massey University Veterinary Teaching Hospital - (06) 350 5329 or email: k.crosse@massey.ac.nz

Thank you.

Kat Crosse and Jonathan Bray            

Companion Animal Surgery Department, Massey University