Pets are like a breath of fresh air on a stifling hot day. But for pets with brachycephalic syndrome, a condition suffered by many dogs and cats with pushed-in faces, getting a breath of fresh air isn’t always easy. The biggest tip-off to the disorder is noisy breathing (e.g., the Pug who snores while he is awake). Snuffling, gagging, exercise intolerance, and tummy troubles are also clues. Many cases are left untreated and, with a proper lifestyle, have no problems. But for some pets, surgery to improve airflow is recommended.


Brachycephalic syndrome, also referred to as brachycephalic airway obstructive syndrome (BAOS), is the term applied to the diseased upper respiratory system common to brachycephalic dogs. This includes Bulldogs and other breeds for which a shortened head is a standard trait.

The structures most notably affected include the fleshy soft palate, which is often overlong (elongated soft palate) and may droop to obstruct the opening of the larynx; the nostrils, which are often too small and narrow (stenotic nares); the larynx, where swollen folds hinder normal air movement (everted laryngeal saccules); and the trachea, which may be too small to accommodate the amount of air required by affected pets (hypoplastic trachea).

Signs and Identification

Noisy breathing is typical of affected animals. Snoring, snuffling, coughing, gagging, and chronic raspiness are signs. Moderate to severe heat intolerance is typical, and heat stroke, fainting, or collapse can occur should owners not abide their pets’ inherent respiratory limitations (such as when taking them for too-long walks or out on hot days). Exercise intolerance and cyanosis (visible as blue-tinged gums and tongue) can also occur, due to their inability to breathe effectively.

Gastrointestinal issues are fairly common for these pets, too. Dogs that gulp air in the process of attempting to eat may belch, gag, regurgitate, and/or vomit frequently. Accidental inhalation of food material into the lungs and resulting infection in the lungs (aspiration pneumonia) is not uncommon in these cases.

Diagnosis is achieved by observing the clinical signs and directly visualizing the affected structures to assess the degree of abnormality. Determining the severity of disease is a necessary step toward deciding what type of treatment is most appropriate.

Affected Breeds

Among dogs, the disease is typically most severe in the English Bulldog. Others include the Pug, Boston Terrier, Pekingese, French Bulldog, Cavalier King Charles Spaniel, Chinese Shar-Pei, Lhasa Apso, and Shih Tzu. However, any brachycephalic dog can develop this condition.

Among cats, the Persian is most affected. Himalayans and Ragdolls can also be afflicted.


Treatment of brachycephalic syndrome is aimed at removing the airway obstruction where possible. In the case of hypoplastic trachea, there is very little that can be definitively achieved surgically. However, stenotic nares, elongated soft palates, and everted laryngeal saccules can all be treated surgically.

Cases that are less severe can frequently be managed through limiting exertion, limiting exposure to heat and humidity, and prescribing medication to alleviate clinical signs when appropriate.

This article has been reviewed by a Veterinarian.