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Brachycephalic Obstructive Airway Syndrome (BOAS)
The word brachycephalic literally means ‘short headed’, and in veterinary medicine we use it to describe patients who have a shortened snout or nose.
Popular brachycephalic breeds of dogs include the English and French Bulldog, Pekinese, Boston Terrier, Pug, Lhasa Apso, Shit Zhu, boxers , Cavalier King Charles Spaniel and Bull mastiff. We also see brachycephalic cats such as the Persians, and rabbits such as the Netherland dwarf.
While not all of our brachycephalic patients have associated health problems the shape of their nose and the head can place them at risk of a condition called Brachycephalic Obstructive Airway Syndrome (BOAS).
BOAS is the term given to the effect the shortened head of these animals has on the passage of air through the upper airways. The signs of BOAS can vary from mild snoring or snorting noises to severe breathing problems which can sadly be life threatening.
Common signs owners may see include noisy breathing, snoring, exercise and heat intolerance, sleep apnoea (where the breathing starts and stops during sleep), regurgitation, vomiting and excessive salivation.
There are four distinct airway abnormalities that can cause BOAS and a patient can have one or more of these abnormalities.
• Narrow nares (nostrils) – small or narrow nostrils which restrict the flow of air through the nostrils when the animal breathes through its nose. In addition the cartilage which supports the nose can be weak and collapse during inspiration (breathing in).
• Elongated soft palate – The soft palate is the soft tissue at the back of the roof of the mouth, it protects the trachea (windpipe) from food during swallowing, but if it is too long it can extend into the back of the throat and rather than protecting the trachea it can obstruct it. A long soft palate can also cause turbulent airflow in the area of the larynx (voice box) and both of these effects increase the effort required by an affected animal when it breathes in, this can make the upper airway very inflamed.
• Hypoplastic trachea – The windpipe or trachea is narrower in diameter compared to a non-brachycephalic individual which makes it harder for the animal to breath especially if its oxygen requirement is increased as it would be during exercise for example.
• Secondary Effects – Because of the abnormalities discussed above Brachycephalic dogs use extra effort when they breathe in, and this eventually causes secondary problems as the airways are not able to adapt to the increased pressure place upon them.
These changes include:
o Gradual collapse of the larynx (voice box) – This is unfortunately a progressive condition.
o Tonsillar eversion and hypertrophy (overgrowth) – The tonsils normally sit in small hollows towards the back of the mouth. They can become enlarged and so protrude into the back of the mouth which reduces the size of the airway still further.
o Pharyngeal muscle hypertrophy – The pharynx is the area at the back of the mouth at the entrance to the larynx (voice box). These muscles become enlarged (hypertrophied) due to the altered pressures in the upper airway.
o Acid Reflux – This occurs when acid from the stomach moves up into the oesophagus (the tube from the mouth to the stomach which carries food). Acid Reflux can cause inflammation of the oesophagus and sometimes ulceration of the stomach – it Is not a comfortable condition. In severe cases a hiatal hernia can occur during breathing – this is when part of the stomach moves into the chest cavity.
o Heart Failure – Thankfully this is less common than the other secondary effects of BOAS.
Our vets will assess your pet’s anatomy during a physical examination. They may ask you about how your dog behaves at home, for example do they snore? They may also ask you to exercise your dog for a few minutes to see if their breathing changes.
Most Brachycephalic animals have some degree of upper airway obstruction (you can usually hear this as snoring or snorting noises).
Following an examination and a discussion our vets (which will include how your pet copes with exercise and warm conditions), will work with you to decide if your pet is experiencing a significant level of BOAS signs or if the shape of their face may predispose him or her to problems.
Unfortunately we can only examine the nostrils properly without anaesthetising your pet. For this reason our initial diagnosis is based on the information obtained during a physical examination and discussion with you, further investigations under general anaesthetic will be needed to confirm the diagnosis.
Further investigations can include blood tests, assessment of the heart with x-rays and/or ultrasound, assessment of acid reflux using x-rays and/or endoscopy (a camera). It is necessary to carry out these investigations under general anaesthetic (other than the blood test which can be done in a conscious patient).
Anaesthesia of brachycephalic patients can be associated with increased risk especially during the induction (as the patient goes to sleep) and recovery (as the patient wakes up) phase. The team here at My Pets Vets is experienced in anaesthetising brachycephalic patients, however in some circumstances we may advise referral to a specialist.
How can we help?
We have a number of options available when it comes to helping your pet and we will work with you to formulate a personalised treatment plan that will hopefully help.
• Stenotic Nares – Surgical removal of a section of the cartilage from the front of each nostril can help improve the airflow through the nose.
• Elongated Soft Palate – Surgical removal of the excessive length of the soft palate can help improve the airflow in this area.
• Laryngeal Collapse – This may be improved by improving the airflow in the area by reducing the size of the soft palate and increasing the size of the nostrils. Sometimes more specialist procedures are needed and our team will discuss this with you should it be necessary for your pet to be referred to a specialist.
• Everted Tonsils – Some patients may be helped by removing the tonsils.
• Acid Reflux – Our team can prescribe regular medications to help your pet with this condition.
• Hiatal Hernia – Our team can prescribe regular medications to help your pet with this condition or discuss surgical options with you if necessary.
• Weight Management – This is an extremely important part of management of the treatment of BOAS. As a lot of patients who struggle with BOAS cannot breath well enough to exercise a lot, they are prone to gaining weight and this additional weight puts increased pressure on their airways. Our team are here to support you with this as we understand how difficult weight management can be for some of our patients, but it is crucial in helping them.
Unfortunately we are never able to create a completely normal airway for brachycephalic animals and we therefore aim to slow the progression of secondary changes discussed above by improving the airflow through the upper airways.
For this reason we may discuss increasing the size of your pet’s nares (should they be stenotic), when your pet is young, sometimes at the time of a neutering procedure in an attempt to reduce secondary changes.
Sadly dogs suffering from BOAS are always going to be susceptible to heat stroke and are unlikely to be able to exercise in the same way as a dog that is not brachycephalic may be able too.
If you are worried about your pet please do not hesitate to talk to us.
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What is kennel cough and why is it important?
Kennel cough is an infectious condition which causes a harsh cough in affected dogs. Most cases are not serious but can make your dog feel poorly for a few days before resolving.
A few unlucky patients may cough continuously and feel really under the weather for a few weeks. We can often help to make your dog feel better if they are suffering from kennel cough so please let us know if we can help.
How is kennel cough spread?
Kennel cough is highly contagious and spreads easily through airborne droplets. This means that dogs that are kept closely together (in kennels, doggy day care centres, parks, across garden fences, vet’s waiting rooms etc) can spread the infection between themselves easily. It is also possible for a dog to pick up kennel cough without meeting an infected dog if they walk in the same area.
What causes kennel cough?
Kennel cough is caused by different viruses and bacteria acting together. Environmental factors can also play a part.
Can kennel cough be protected against?
No vaccine can offer complete protection against kennel cough (this is because the viruses and bacteria involved can be different from one case to another). Thankfully we do have vaccines available which help protect against the most commonly involved virus (canine parainfluenza virus) and the most commonly involved bacteria (Bordetella bronchiseptica).
Many dogs have protection against the parainfluenza virus via their yearly vaccinations. Vaccines against Bordetella are also available and are traditionally given as drops up the nose. We are able to also offer a Bordetella vaccine that is given into the cheek pouch of your dog.
Many boarding kennels, dog walkers and doggy day care centres require Bordetella vaccination.
Should I have my dog vaccinated against kennel cough?
We recommend that you consider the Bordetella vaccine if your dog is healthy dog and socially active – if it meets other dogs in kennels, doggy day care or out on walks or if it walks on areas that other dogs also enjoy.
My dog is due to go into kennels, when should I make an appointment for the kennel cough vaccination?
The new Bordetella vaccine which is given into your dog’s cheek pouch needs to be given 21 days before your dog goes into kennels to ensure that it is providing optimal protection against the bacteria.
If your dog is socially active all year we would advise you consider having the vaccine administered at the time of your dog’s annual vaccinations. (We offer a discount making it a more cost-effective option as well).
Are there risks or side effects of vaccination?
Some dogs have mild symptoms of coughing, sneezing or discharge from the eyes or nose for a few days following the vaccine. Occasionally these signs persist for longer. Other side effects are extremely rare.
Are there are any reasons why my dog should not be vaccinated against kennel cough?
Your dog should not receive Bordetella vaccination if they:
- Are already receiving antibiotics (the vaccine is unlikely to do harm but it probably won’t work)
- Are Coughing or has a known respiratory condition.
- Are suffering from a known problem with their immune system, if a problem with your dog’s immune system is strongly suspected by your vet or if your dog is receiving drugs to suppress its immune system.
- Have previously had a serious adverse reaction to vaccination.
- Have had a vaccine made by a different vaccine company within the previous 2 weeks (we can advise you on this)
- Is generally unwell (the vaccine may not work).
If you are immunocompromised or if any member of your family/close friends who come into contact with your dog are immunocompromised, please let us know before we administer the Bordetella vaccination so we can discuss this with you in further details.
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You may have seen articles in the press and online discussing the over vaccination of pets and the discussion of titre testing.
We wanted to put some information together to allow you to make an informed choice regarding vaccination for your pet.
A titre test is a blood test that can show whether your pet has antibodies for a particular illness.
Titre testing can be used to determine the effectiveness of a vaccine or the presence of any natural immunity towards disease.
Your pet needs antibodies against individual diseases to enable their body to attack the pathogen (disease) and remove it from their system.
Therefore the presence of antibodies to a particular illness may suggest that your pet is immune to that illness.
Unfortunately things are not that simple and whilst a titre test can show antibodies for certain illnesses it may not be useful in determining true immunity (the bodies ability to defend itself against that illness).
There are two different types of immunity in our patients – antibody immunity (measured by titre testing) and cell immunity (which is not measured by titre testing). The two types of immunity are believed to normally correlate but it is not clear how much.
This means that the presence of antibodies, or their absence, may not necessarily tell us if your pet will or will not get a disease.
To complicate things still further titre tests are not 100% reliable and there are many different tests available on the market. It is possible to get false negative results (where the test says your pet has less antibodies than it actually does) and false positive results (where the test says your pet has more antibodies than it actually does). False positive results can lead you to believe that your dog has antibody protection against disease that it doesn’t have.
As a UK veterinary practice we believe that vaccination against the core diseases (canine parvovirus, distemper, canine hepatitis and leptospirosis for dogs; feline panleukopenia virus, feline herpes virus and feline calicivirus) and non core diseases (including kennel cough and feline leukaemia virus) protects your pet and the wider animal population by minimising the chances infectious disease has to infect new victims.
We strongly advise that puppies and kittens are given their initial vaccines when they are young as the immunity they get from mum starts to drop as they get older and needs a boost. This initial vaccine course comprises of two vaccines given 2 – 4 weeks apart for dogs and 3-4 weeks apart for cats, followed by their first ‘booster’ when they are just over a year old.
The protection from the leptospirosis vaccination does not last a long time and it is for this reason we recommend yearly vaccination against this disease. We know that the immunity for the other diseases does last longer and it is because of this knowledge that we vaccinate against parvovirus, hepatitis, and distemper every 3rd year.
We advised that you vaccinate against kennel cough if your dog is socially active – if it meets other dogs in kennels, doggy day care or out on walks or if it walks on areas that other dogs also enjoy.
For our feline friends the use of vaccinations and the length of their immunity is an area under much investigation and study currently.
We can also vaccinate against Rabies if your pet is travelling abroad and this is a legal requirement.
If you would rather we titre test your pet to check their antibody levels to canine parvovirus, hepatitis and distemper before they receive their vaccine please let us know and we can arrange to take a blood sample and run the test.
All of our vets are more than happy to discuss our vaccination protocols and provide you with any information you may need to make an informed choice that is right for your pet and your family.
It is important to note that some establishments (such as boarding kennels, catteries or doggy day care providers) will not accept your pet unless they have a full vaccine history in line with manufacturer guidelines. Pet insurance companies may refuse cover or reject a claim relating to an illness that could have been prevented by vaccination.