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Brachycephalic Airway Syndrome in Dogs

What is Brachycephalic Airway Syndrome (BAS)?

Brachycephalic comes from two Greek words meaning ‘short’ and ‘head’. Brachycephalic dogs typically have a short, squashed nose. 

In recent years, breeding selection for extreme brachycephalic features has resulted in dogs that are predisposed to breathing issues or Brachycephalic airway syndrome (BAS). 

The signs can vary in severity from mild snoring or snorting noises to severe breathing problems, collapse and even death.

Breeds at risk include: English Bulldogs, French Bulldogs, Pugs, Boston Terriers, Dogue de Bordeaux, Cavalier King Charles Spaniel, Lhasa Apso, Shih Tzu and Pekingese.

Dogs with BAS have difficulty breathing because they have stenotic nares (narrow nostrils) combined with an overlong soft palate. The extra effort required to breathe in results in secondary problems including: 

  • Laryngeal collapse 
  • Tonsillar eversion and hypertrophy:
The increased negative pressures can cause them to enlarge and protrude into the back of the mouth, further narrowing the airway. 

  • Pharyngeal muscle hypertrophy:
The pharynx is the term used to describe the area of the back of the mouth and entrance to the larynx. These muscles can become enlarged due to the altered pressures in the upper airway. 

  • Acid reflux from the stomach into the oesophagus. This can result in inflammation of the oesophagus and sometimes in ulceration of the stomach. 
  • Heart failure. Laboured breathing puts increased pressure on the heart to deliver oxygen to the body.

What are the clinical signs of Brachycephalic Airway Syndrome?

Zulu and his brother Zidane
(see case study below)
✔️ difficulty breathing (dyspnoea

✔️ noisy breathing (stertor

✔️ exercise intolerance 

✔️ regurgitation / vomiting 

✔️ overheating (see advice on heat stress prevention)

How is Brachycephalic Airway Syndrome diagnosed? 

Your veterinarian will make a diagnosis based on history, clinical signs and a thorough clinical examination. Unfortunately, only the nostrils can be assessed in consult

To fully assess the structures at the back of the throat the dog needs to be anaesthetised

Laryngoscopy/endoscopy is sometimes used to assess the airway and CT scans give a detailed image of the structures within the nose and throat. Often surgical treatment will be performed at the same time as this assessment to reduce the need for multiple anaesthetics. 

The easiest time to do this would be at the time of desexing

It is better to correct airway abnormalities sooner rather than later to prevent any secondary problems. 

What is the treatment for Brachycephalic Airway Syndrome?

Surgery to correct the anatomical abnormalities is the treatment of choice in dogs suffering with BAS. 

Surgery involves: 

✔️ Widening stenotic nares (this means that the nostrils are pinched or narrow)
✔️ Shortening of the soft palate 

The surgeon will assess the larynx (voice box) and decide whether additional surgery in this area is appropriate or likely to be beneficial. 

Some cases may benefit from tonsillectomy (removal of the tonsils). 

Weight loss can also dramatically improve the airflow through the pharynx and neck and MUST form part of the treatment protocol in overweight dogs.

Zidane's Story

Zidane presented to us at Southern Cross Vet for snuffling and sneezing. 

Upon questioning the owners, this was the third time they had been to the vet this year for the condition. They weren’t overly worried about it, but with further questioning, the owners reported over the past six months some things of concern to me:
  • Snoring at night 
  • Panting and noisy breathing a lot more than other dogs at the park while running around, the owners also noticed Zidane panting all the way home in the car.
  • I asked them about recovery from exercise and the owners advised that it takes about 30 minutes to recover after exercise. When I told them that normally, healthy dogs should recover from intense activity in around 10 minutes maximum.
  • Sometimes regurgitating or vomiting after drinking water or eating food
  • Even when its not hot, breathing through their mouth (not nose as is normal for a dog)
I turned my computer screen around to face the clients and with some videos and showing anatomy pictures to them explained that I feel there are compelling signs of a long soft palate (back of the throat) which was causing ‘upper respiratory obstruction’ also known as BAS or BOAS (In the UK). I also showed the family pictures of what a healthy normal nose should look like with circular, round nostrils; a stark contrast to the vertical, narrow ‘slits’ that Zidane had. They didn’t need to be vets to see this problem clearly with their own eyes.

I told them the good news was that we could help and with our new minimally invasive technique, Zidane's recovery would be smooth as silk and he could even go home a few hours after the procedure.

We explained the costs, risks and likely outcome of the BAS procedure at Southern Cross Vet and we scheduled in the surgery for Friday in two weeks time. Friday suited the family very well as they didn’t even need to take time off work to be there for their dog's recovery.

Friday came quickly, and the procedure occurred with no complications and everything going to plan. While the family were anxious, the nursing team kept them updated throughout the day so they knew how Zidane was doing, and this we were told, made them so much more relaxed.

Our minimally invasive technique uses some high tech equipment no one else is using in Australia.

This means there’s no bleeding when we shorten the soft palate; lasers are used to open up the sinuses, and a special hand piece comfortably seals tissues with precise radiowaves, rather than cutting using painful blades; above all, nothing foreign is left behind in the throat that tickles for weeks after surgery and they don’t need to have 24/7 monitoring overnight and can be at home with their family.

Immediately after the procedure, the vital signs on the anaesthetic monitoring machines improved – the oxygen saturation measurement increased, the respiratory rate reduced – signs that breathing was already easier.

As with all surgical cases, we saw Zidane 3 days after the operation, and while there was a bit of redness, this was deemed normal. We saw him again 7 days later when most of the sutures had dissolved and the owners were elated.

They had taken Zidane to the park for the first time, and he outran his mate Luna the Dachshund for the first time ever!

He still snores at night, but Zidane's family think this is kind of cute as snoring runs in their family anyway; but he no longer regurgitates after eating, and even when it is hot, he’s always settled when he gets back into the car after a romp in their park and by the time he gets home, he’s not breathing noisily and is settled.

We knew Zidane appreciated the difference we made to his life after we were invited to his 2nd birthday celebrations!

How successful is the outcome? 

After appropriate treatment dogs can experience a significant improvement in exercise tolerance and ease of breathing.

What is the best prevention for Brachycephalic Airway Syndrome?

1. Weight management is essential

2. Be careful about exercising in warm weather

3. Use a dog harness instead of a neck collar on walks

4. Ensure your dog's collar is not too tight

5. Avoid choosing dogs with exaggerated features – i.e. an excessively squashed nose. 

6. If buying a puppy (from a reputable breeder), try to get as much information as possible about the breeding parents. 

Dogs that show any sign of suffering from BAS should not be bred from

 that have received treatment for BAS and can now breathe should also not be bred from, as BAS is an inherited condition.

written by
 Dr Sam Kovac, Southern Cross Vet, December 2019 (all rights reserved) for Australian Dog Lover.

About the writer
Dr Sam KovacBVSC (Merit)), Chartered Member of the Australian Veterinary Assoc. , Member Royal College of Vet Surgeons, UK, MSGFC

Dr Sam followed his dream of becoming a veterinary surgeon that began at age three. Since that time, he has developed a strong interest in oncology, internal medicine and animal behaviour. Now a Chartered Member of the Australian Veterinary Association, Dr Sam continues his passion of providing the most up-to-date care to his patients and their two-legged family.

Sam founded Southern Cross Vet in the heart of St Peters, bordering on Alexandria to the 
west, Marrickville to the east and Newtown to the north, to offer pet parents a new level of service but with reasonable fees.

You can follow Southern Cross Vet on Facebook at or Instagram at

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