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Clinical
Respiratory

Brachycephalic obstructive airway syndrome: a respiratory review

02 June 2024
Clinical
14 mins read
02 June 2024
Volume 29 · Issue 6
Figure 1. Nostril grading examples (University of Cambridge, 2018).
Figure 1. Nostril grading examples (University of Cambridge, 2018).

Abstract

This article reviews the pathogenesis, diagnosis and therapeutic options for the respiratory aspects of brachycephalic obstructive airway syndrome. Brachycephalic obstructive airway syndrome is a condition estimated to affect around 50% of the brachycephalic dog population, which, over recent decades, has seen a meteoric rise in popularity and ownership. Several primary and secondary respiratory abnormalities that can compromise the respiratory capacity of these patients should be considered. Diagnosis primarily takes the form of clinical examination and the use of an exercise tolerance test, with other diagnostics acting as a useful adjunct in fully detailing the abnormalities present. Treatments are mainly focussed on increasing the amount of space within the upper respiratory tract through removal of various primary and secondary anatomical abnormalities; however, the optimal methods are yet to be identified. While understanding of these breeds' respiratory issues has increased among owners and the veterinary profession, there are still many challenges and unknowns in the management of these patients. It is important veterinary professionals take an active approach to these patients and are able to effectively communicate which are affected in order to maximise the welfare of this cohort and uphold their ethical responsibilities to them.

Brachycephalic obstructive airway syndrome is a chronic, lifelong, hereditary, respiratory condition related to the shortened skull and muzzle confirmation of brachycephalic patients. Kennel Club registrations of brachycephalic dogs saw a marked increase over the past decades with increases of 193%, 3104% and 96% of pugs, French bulldogs and bulldogs respectively between 2004 and 2017 (British Veterinary Association, 2021). More recent data show that registrations of bulldogs continue to climb, while that of pugs and French bulldogs have reduced from their peak but are still very high (Kennel Club, 2023), despite ongoing campaigns to highlight the health concerns related to the breeds (RSPCA, 2022) and reduce their use in media advertising (Blue Cross, 2021). Around 50% of extreme brachycephalic breeds including the pug, French bulldog and bulldog are functionally affected by brachycephalic obstructive airway syndrome (Liu et al, 2016). Approximately 20% of brachycephalic patients are presented to primary care practice for an upper respiratory tract disorder within their lifetime (O'Neill et al, 2015). However, given that around 60% of brachycephalic dog owners may not perceive their dog has a breathing problem (Packer et al, 2012; Liu et al, 2015), it is likely many more of these patients are suffering from brachycephalic obstructive airway syndrome without intervention. This article reviews the current understanding around the respiratory component of this complex condition, alongside the diagnostic and therapeutic options available.

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canine
brachycephalic obstructive airway syndrome
respiratory
surgery