Brachycephalic obstructive airway syndrome (boas) and breathing problems in flat-faced dogs

Many of us know and love breeds that look a little different than the rest – the group of dogs known as brachycephalic. More common descriptive terms include flat faced or smushed faced.

While the word brachycephalic has become more widely recognised, many pet parents don’t really realise the full implications for their dog.

Here’s what brachycephalic obstructive airway syndrome (BOAS) actually means for our best friends.

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So what exactly is BOAS?

Brachycephalic obstructive airway syndrome, or BOAS, is used to describe a collection of anatomical changes including the airways and the back of the throat. These changes have slowly progressed over time and can be severe in some pets.

All brachycephalic dogs are affected by BOAS in some capacity. Some may not experience much of a problem regularly, but there are still limitations owners need to be aware of.

Brachycephalic pets have a more flat-faced appearance because they have a more prominent lower mandible (jaw) and a more compacted upper portion of the head. Many can have a significant underbite and teeth crowding because of this.

Generally speaking, the skeletal system and conformation of these types of dogs is just small compared to other dogs of the same size.

Unfortunately, the most recognised feature of the brachycephalic is increased sounds when they breathe, which is a result of the deformities of their faces and respiratory system.

People often think this is ‘ok’ or normal for the breed, but these abnormalities do present these dogs with lifelong challenges.

Brachycephalic features

The collection of anatomical changes that make up BOAS include:

1. Stenotic nares: This term means narrowed or skinny nostrils, and is a big part of BOAS. When dogs have smaller openings to the nose, this often means they struggle or pant to get more airflow.

2. Hypoplastic trachea: This term refers to the trachea (our main largest airway) having formed being too small/not as wide as it should be. Thus, these pets work harder to move air in and out of the lungs as effectively.

3. Everted laryngeal saccules: This term refers to two small areas of tissue on either side of the back of the throat near the cartilage called the larynx. Normally the tissue is tucked inward nicely, but in dogs with BOAS they are flipped outward and can obstruct airflow.

4. Elongated soft palate: The soft palate is the tissue on top of/at the back of the throat that helps keep the airways and throat separated from each other. Because of the abnormal shape of the brachycephalic pet's skull, this tissue is usually too long and too big for that area and ends up partially or almost fully blocking airflow. Sometimes the dog’s tongue is also too large for the space available and contributes to difficulty breathing.

Which dog breeds get BOAS?

BOAS is most commonly recognised in English and French bulldogs, particularly as irresponsible breeding has led to the increase in severity and frequency of these anatomical changes over time. There are, however, many more breeds that can be affected including:

• Pugs

• Boxers

• Shih Tzus

• Pekingese

• Lhasa Apsos

• Boston Terriers

• Affenpinschers

• Brussels Griffons

Even some Staffordshire Bull Terriers, Mastiffs, Chow Chows, and Cavalier King Charles Spaniels can be affected.

Cats and BOAS

BOAS doesn’t only affect dogs! There are several breeds of cats that are brachycephalic and can show signs of BOAS including:

• Persians

• Himalayans

• Exotic/British/American Shorthairs

• Burmese

Signs and symptoms of BOAS

Signs of BOAS will vary in type and severity. Thing owners should be watching for include:

• Excessive snoring (including snoring sounds even when awake)

• Sleep apnea (breathing stops temporarily while sleeping then abruptly restarts, often waking the pet)

• Stertorous breathing (increased airway sounds originating in the nasal passages/upper airway)

• Exercise intolerance (slower during and after activity)

• Collapse

• Trouble recovering from warm temperatures

• - Regurgitating or vomiting

Most cases are diagnosed based on the dog’s history and a clinical examination alone. More advanced diagnostic testing including an anaesthetised exam of the larynx and imaging like a head CT scan can help assess the severity of the disease.

A side note on BOAS and hot weather…

We know that senior pets, overweight pets, and pets with underlying diseases such as heart conditions can suffer much more than healthy pets in hot weather. But brachycephalic breeds suffer the same intolerance to warmer temperatures.

Most healthy adult dogs remain comfortable in temperatures up to around 20C before we need to be more conscious about what activities we’re doing outdoors with them.

At-risk dogs, including brachycephalics, have an even lower threshold, likely only up into the high teens (17-19C). This is primarily because moving air through their airways is more difficult, as is panting, so getting rid of excess heat is a challenge.

Some important tips for brachycephalic pet parents in warm weather include:

1. Avoid activity during the warmest part of the day (i.e. walk only in the early mornings or late evenings)

2. Be diligent about keeping an eye on the temperature

3. It’s completely ok to skip your walk if the weather is really toasty

4. Ensure your pet always has free access to water at home

5. Be sure to carry water with you when you’re out with your pet

6. Consider fans and cooling pads at home, particularly if you don’t have air conditioning

BOAS treatment and surgery

While dogs can’t be cured of BOAS, there are a few surgical procedures to help alleviate the issues associated with it.

The most common is surgical widening of the nostrils, along with removing a portion of the soft palate to shorten it. Our end goal is to decrease the amount of tissue inhibiting the normal flow of air.

It can make a massive difference in the quality of life of the animal. It is, however, important that owners remember that most cases, particularly severe cases, will continue to need support and management long term.

Often, your vet will refer you to a specialist for these procedures.

How much does BOAS surgery cost?

In 2021 1,407 claims for BOAS in 2021 with an average claim cost of £1,630.39. But surgery can cost a lot more.

Some example costs we found of BOAS surgery packages were:

• £2,000 from a vet in Somerset

• £2,750 in Derbyshire

• £3,250 at a surgery in Leeds

• £3,610-£4,120 depending on the procedure at a vet in Bedfordshire

Owners may not be able to fix the problem, but there are a few key points to remember to help your pet if they’re affected by BOAS.

Picking appropriate and safe ways to exercise, avoiding excessively warm temperatures, and maintaining a healthy body weight are all a must when being thoughtful about your brachycephalic pet’s airways!

Buying a brachycephalic breed puppy

Bringing home a brachycephalic breed is definitely a commitment on the owners part to be a diligent pet parent.

If you’ve got your heart set on a brachycephalic breed like a Pug or a French Bulldog, it’s really important that you look for a breeder who is encouraging responsible stewardship. This means they are following recommendations to improve breed standards.

Due to a long history of irresponsible breeding alongside increasing breed popularity, these pets' anatomical genetic abnormalities have become increasingly severe to the point that they are compromising pet health and welfare.

The British Veterinary Association (BVA) is currently in support of the Kennel Club’s Breed Health and Conservation Plans, particularly for brachycephalic breeds. They’re also committed to driving improved breed standards.

It’s essential that owners are well educated on the health issues with brachycephalic breeds. This doesn’t just include BOAS (thought that is a major factor).

Some other issues for brachcephalic breeds include:

• Dermatological disease/allergic skin disease particularly in areas of facial skin folds

• Increased risk of eye issues as many brachycephalics eyes protrude further from the eye orbit due to flat face shape

• Increased anaesthetic risk secondary to abnormal airway anatomy

• Increased likelihood of gastrointestinal irritation secondary to breathing difficulties

• Chronic damage to the larynx due to harsh airflow over long periods of time

Despite the challenges, many brachycephalic breeds have legions of affectionate fans and not just because of how they look. Breeds like Pugs and French Bulldogs have so many desirable qualities that make them fun family dogs that they’re some of the most popular breeds in the UK.

But if you’re considering a brachycephalic pup, just make sure you ask the right questions about the parents’ health, know that you’ll be responsible for your new pet’s health and consider taking out a good level of pet insurance as soon as you bring them home so they’re covered for any future conditions they may develop.

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