Pugs and French Bulldogs, and to a lesser degree English Bulldogs, have become incredibly popular in recent years. These dogs appeal to many people because of their looks and great character. Whenever a breed becomes very popular, it also presents an opportunity for money making and unscrupulous breeding. Buyer-beware, definitely applies to these dogs.

If you have a brachycephalic dog, or you or anyone you know is thinking of getting one, you need to be very aware of the significant health problems these breeds are affected by. This article will give you a concise summary of the possible issues suffered by these dogs.

“Brachy" means “shortened" and "cephalic" means "head". The skull bones including the jaw bones of brachycephalic dogs are shortened in length, giving the face and nose a pushed in flat appearance. This flat faced feature is something that has been produced by purposeful breeding resulting in the exaggerated features we now see in the following breeds: Pugs, French and English Bulldogs, Boston Terriers, the Pekinese and Shih-Tzus. Cavalier King Charles Spaniels and Staffordshire Bull Terriers and Boxers, can also be affected, although less commonly.

The shortened jaw bones and compacted skeleton in these breeds cause a number of malformations especially in their nasal cavities, mouth, and throat but also in the spine and tail. The throat and breathing passages in these dogs are undersized due to the very short jawbones. However, they have normal amounts of skin and soft tissue. Their soft tissue is therefore excessive for their skeleton, giving rise to the obvious skin folds these dogs have on their faces. The problem is, that that similar folds and excessive soft tissues are also present inside, leading to a number of obstructions affecting their airways. The tongue which would be of appropriate size for a longer face is also too big for their shortened mouth and obstructs the throat further.  These dogs suffer, to a varying extent, from Brachycephalic Obstructive Airway Syndrome (BOAS). This condition impacts on all aspects of a brachycephalic dog’s life. (A study in 2015 found that 88% of Pugs suffer from BOAS with French Bulldogs coming in a close second, and surveys have found that approx. 63% of bulldogs and 18-50-% of Boxers suffer from BOAS).

Signs and symptoms brachycephalic dog owners should recognise.

• Respiratory noise: Dogs with normal upper airway tracts breathe quietly. Respiratory noises such as snoring and snorting are common in flat faced breeds. This does, however, not make it “normal”, as some breeders will have you believe, and it is not without negative health consequences. The noise is simply an indicator of airway obstruction. 

• Stenosis/narrowing of the nostrils: The nostrils are excessively narrow and often collapse inward during inspiration, making it difficult for the dog to breathe through the nose properly. As a result, respiratory effort and open-mouth breathing are commonly seen in brachycephalic dogs.

• Gastrointestinal signs: Eating difficulties are commonly seen in these dogs as the excessive internal soft tissue and folds impedes the swallowing function. Regurgitation/ reflux is also often seen in these dogs. This is caused by the chronic increase in thoracic airway pressure which draws the stomach into the chest.

• Obstructive sleep apnea: Breathing difficulties during sleep and periods of no breathing can be observed in these dogs during their sleep. The dogs tend to choke when they fall into sleep, which wakes them up until they snooze again, and so on. Many brachycephalic dogs are consequently chronically sleep deprived. Some dogs sleep on their back or try to sleep propping their heads up to make it easier to breath. This condition can be life-threatening.

• Heat intolerance: Dogs are not able to sweat like humans do but rely on the nose and the mouth to act like a radiator to cool them down and regulate their temperature when they breathe and pant. Due to their short jaw bones and narrow air canals, these breeds cannot exchange heat as easily as dogs with normal jaw and nose length when their body temperature rises during exercise.  The poor temperature regulation means they can easily suffer from overheating and heat stroke, which can lead to organ dysfunction. Other symptoms to look for include excessive panting, excessive drooling, glazed eyes, increased pulse, vomiting/diarrhoea, excessive thirst, dark red tongue, staggering and rapid heart rate.   In severe cases, they may seizure, collapse, become unconsciousness, or die.

• Cyanosis and collapse: The difficulties of breathing in flat faced dogs means they may not be able to meet their oxygen requirements during exercise and sleep. When their blood is inadequately oxygenated, their skin presents a bluish discoloration, which is an obvious sign of cyanosis that can be easily recognized in the dog's tongue and gums. Occasional collapse is common, especially following over-activity, excitement, or excessive heat or humidity.  If the dog's oxygen levels are not stabilized immediately the dog may become unconscious or even die. 

Other conditions seen in flat faced breeds:

• Vertebral deformities over the thoracolumbar spine which can cause compression of the spinal cord, leading to weakness in the back limbs or even paralysis.
• Deformed (cork-screw) tails can also cause discomfort, either by poking into the perineum or by causing chronic skin fold disease.
• Skin infections in the excessive folds of skin around the nose.
•  The crowding of teeth in their small mouths can cause infections and pain requiring extensive dental work.
• The lack of space in the scull producing the bulging eyes often seen in these breeds lends them vulnerable to eye injuries and ulcers, which was the most common condition affecting Pugs in the 2014 national health survey. 

What can owners do to help their dogs and prevent unnecessary suffering?

1. If your dog is brachycephalic, you should seek a veterinary opinion to determine whether your dog would benefit from being treated for BOAS, which includes various surgical procedures to widen the airways. Corticosteroids, non-steroidal anti-inflammatory medications and oxygen therapy may also be used for short term relief of airway inflammation or respiratory distress.
2. Since obesity worsens the symptoms of brachycephalic airway syndrome, keeping these dogs slim or weight loss is an important part of treatment if the pet is overweight.
3. For dogs with only mild or intermittent symptoms, their condition may be managed conservatively by controlling exercise levels and avoid exercising your dog during hot summer days. Keep your dog away from hot or humid environments, keep the dog in an air conditioned or cool place during the summer. Avoid situations that may cause too much excitement or stress.
4. Dogs with brachycephalic airway syndrome should be fitted with a harness that does not tug at the neck area. It is not advisable to use a regular neck collar for these dogs since the collar can put undue pressure on the neck and further exacerbates their breathing problems.
5. Dogs with pronounced breathing difficulty or dogs that require surgery to correct airway obstruction should not be used for breeding. Look for dogs where the skin folds above the nose do not protrude over the nose itself. Walk away from any breeder that tells you their breathing problems are nothing to worry about or who cannot demonstrate that both parents have been health tested. The puppies should also be Kennel Club registered. You can find advice from the Kennel Club as to which tests should be done on dogs used for breeding.

This is unfortunately rather grim reading. But, unless potential buyers are aware, and breeding practices of these dogs are quickly changed to gradually lengthen their jaw bones and reduce the excessive flat faced characteristics seen in these breeds, they will continue to suffer significant health problems as well as causing distress to their owners and a financial burden. I am sure true lovers of these breeds would like to see the health issues taken seriously and reduced by responsible breeding. These lovely dogs have every right to lead a healthy life free from unnecessary suffering.

References

1. Department of Veterinary Medicine, Cambridge Veterinary School, www.vet.cam.ac.uk/boas/about-boas
2. Fitzpatricreferrals, www.fitzpatrickreferrals.co.uk/soft-tissue-service/brachycephalic-syndrome
3. Kennel Club Pedigree Breed Health Survey 2014,
4. Packer R.M.A. et al. Impact of Facial Conformation on Canine Health: Brachycephalic Obstructive Airway Syndrome, PLoS one 10, 10, 2105
5. Pippa Mattinson, Choosing the Perfect Puppy, Penguin random house group, 2017