Brachycephalic Airway Syndrome in
Bulldogs and French Bulldogs

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs is also known as “Bulldog Brachycephalic Syndrome”. “Brachycephalic” is Latin for “flat head”,  the bulldog flat headed condensed facial structure has an undesirable effect on the anatomy of the neck and head and its relation to the respective soft tissues and other structures.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs ANATOMICAL ABNORMALITIES: 

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs refers to a set of primary and secondary upper airway anatomical abnormalities.

The BAS primary and secondary abnormalities are caused by the narrowing of your bulldog’s upper airways, increased airway resistance, and increase negative intra-airway pressure.

If this negative intra-airway pressure exceeds the resistance of the surrounding tissue, inflammation, swell and edema of the laryngeal tissue will occur, which will further narrow the airways and further increase the effort required to inhale.

BCS PRIMARY ABNORMALITIES: 

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs

BCS SECONDARY ABNORMALITIES: 

  • Hypoplastic trachea
  • Enlarged protruding tonsils
  • Laryngeal collapse.

Your bulldog may be affected by a combination of one or more of these abnormalities.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs CLINICAL PRESENTATION: 

STRIDOR:  One of the most common clinical signs of brachycephalic airway syndrome in bulldogs and French bulldogs is a harsh “mechanical”  high-pitched respriation resulting from turbulent air flow in the larynx that is worsened by exercise or excitement and is exasperated by warm weather.

STERTOR:  Characterized by heavy snoring and gasping during inspiration due to naso, naso- pharynx or pharynx obstruction. The sound can be heard awake or asleep with apena.

  • Stridor & Stertor
  • Acute hyperthermia (as high as 106f)
  • Hypoxia (oxygen deficiency)
  • Cyanosis (blue-purple tongue due to oxygen deprivation)
  • Fainting (syncope)
  • Asphyxiation
  • Pulmonary edema
  • Heart failure
  • Sudden death
Brachycephalic syndrome in bulldogs and French bulldogs stenotic nares before and after

Stenotic Nares in a French Bulldogs Before & After surgical correction by Dr. Kraemer

EARLY INTERVENTION: Due to the seriousness of bulldog and French bulldog brachycephalic syndrome and it progressive nature early intervention is critical.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs DIAGNOSIS: 

Stonic Nares: Simple visualization, during the physical exam.

Hypoplastic Trachea: Radiographs are usually sufficient.

Elongated Soft Palate: ESP initial diagnosis is auditory and can be done with videos taken by the bulldog owner during activity or excitement, and by the medical team during the exam.

The definitive diagnosis is a visual inspection that must be done under mild sedation, and proper lumination.

Everted Laryngeal Saccules: The definitive diagnosis is a visual inspection combined with a respiratory stimulating drug. and must be done under mild sedation and proper lumination.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs PROGNOSIS: 

The overall prognosis for English bulldogs, french bulldogs, and other brachycephalic breeds depends on how many anatomic abnormalities are present at the time of diagnosis and how soon they were corrected.

Stenotic Nares: 

Bulldog Stenotic Nares means narrowed or pinched nostrils; the narrowing restricts the amount of air that can flow into the nostrils. Bulldog and French bulldog Stenotic Nares can be surgically corrected by removing a wedge of tissue from the nostrils….Read More

Brachycephalic syndrome in bulldogs and French bulldogs elongated soft plate in bulldogs

elongated soft plate in bulldogs

Elongated Soft Palate: 

Sadly, the natural anatomical boundaries of the soft palate were altered as a direct aftermath of selective inbreeding. The elongated obstructing space critical for respiration thus should be surgically trimmed as early as possible….Read More

Hypoplastic Trachea: 

Bulldogs with this condition have an abnormal narrow windpipe that restricts airflow and proper breathing. As with the other upper airway abnormalities, narrowing of your bulldog airways can cause increased airway resistance, as well as an increase of negative intra-airway pressure.

In contrast to the common notion, it is my experience that Trachea Hypoplasia appears to be tolerated well in bulldogs in the absence of concurrent respiratory, heart disease, and conditioned on normal or repaired Bully Stenotic Nares and Bully Elongated Soft Palate

Everted Laryngeal Saccules:

Are small sacs or pouches that are located just inside the larynx; these saccules turn outwards due to the abnormal negative pressure accompanying the increased respiratory effort associated with the Brachycephalic syndrome, these bulging prolapsed saccules will further obstruct airway flow thus should be surgically removed.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs MAINTENANCE: 

WEIGHT CONTROL: weight management is critical for bulldogs suffering from BCS.
EXCERSICE RESTRICTION: controlled exercise and minimal excitement
CALM & RELAXED: calm environment is critical. To help reduce the stress you provide a supplement like Dr. Kraemer’s V4B Bully Calm & StressLess Chews.
COOL: avoid heat and humid conditions.
SURGERY CORRECTION: It’s important to note, that medical management of those conditions does not correct the underlying anatomical abnormalities, but merely lessens the symptoms.

Surgery is the treatment of choice whenever the anatomic abnormalities interfere with normal respiration

Brachycephalic syndrome in bulldogs and French bulldogs soft palate

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs RULE OF THUMB: 

  • The more abnormalities present the more severe are the symptoms.
  • The sooner those abnormalities are corrected (surgery), the better the prognosis.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIPS & WARNINGS: 

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP #1: I recommend surgical repair of the elongated palate and/or stenotic nares as soon as your bully reached maturity at about 8 months of age.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP #2: In an event of a respiratory crisis you should check rectal temp, normal is between 100-102.5 F. If it is over 105 F, and you can’t get to a veterinary hospital, rinse your dog with cool water and place a fan over him/her till the temp drops to 103, don’t let it go below 100F.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP #3: The thick large bully tongue often retracts inward to further compound the respiratory crisis. If you bully is in respiratory distress or collapse, make sure he/she is sternal (i.e. laying on sternum/chin, rather then on the side). Pull your bully tongue so it is stretched out, keep watching the color of the tongue, pink is good, purple-blue is bad

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP#4: Bulldog suffering from BCS often gag and vomit.  to prevent aspiration (i.e. aspiration pneumonia) you should:

  • SLOW FEEDING: don’t let your bully eat or drink too fast. To slow them down, use cupcake cups or place objects in their water/food dish.
  • SOFT FOOD: use a blended diet and mix it with water to form a thick soupy meal.
  • SMALL & FREQUENT: Feed smaller portions and more frequent meals
  • ELEVATED FEEDING: feed your dog on a step to elevate his upper body, the more vertical the better.
  • ANTI ACID RX: last, to decrease stomach acidity and gastric reflex, discuss with your vet daily RX like anti-acids (i.e. pepsid-c and Prilosec) and antiemetic’s (anti-vomit) medication.
Brachycephalic syndrome in bulldogs and French bulldogs Everted prolapsed saccules

Everted prolapsed saccules in bulldogs. Note the 2 pink obstructive bulges in the photo.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP #5: I recommend a harness rather than neck collar to prevent airflow restriction (all bulldogs)

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP #6: Read my anesthesia & Sedation chapter and recommendations. I customed special pre-anesthesia bulldog protocols that include anti-vomiting, anti-stress/anxiety medication, anti-inflammatories, and pain relief. My protocol is specially designed to minimize the breed-related anesthesia risks and to maximize the recovery safety Finally, To improve lung condition, we always initiate pre-anesthesia oxygenation by 100% oxygen flow or masking.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs TIP#7 Bulldogs with BCS have an increased risk of complications associated with general anesthesia thus I recommend

  • LAB WORK: routine pre-anesthetic blood work.
  • RADIOGRAPHS: Chest x-rays could be taken to evaluate the esophagus (megaesophagus), trachea (Hypoplastic), lungs (aspiration pneumonia), heart (heart disease) and diaphragm (hiatal hernia).
  • ECG: Electrocardiograph screening

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING#1: Symptoms are often worse in hot or humid weather.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING#1: #2: In the early postoperative period, swelling of the surgical sites (laryngeal edema) may occur and interfere with breathing. Thus, we closely monitor our bulldogs after extubation.

In my opinion, the post-extubation period is the most CRTICAL part of “bulldog anesthesia”. At my practice, we assign a trained technician to seat next to our patient, and monitor vitals till they are extubated and breathing by thermslef for a while

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING #3: I don’t recommend breeding a bulldog who has required surgery to correct airway obstruction.

Brachycephalic syndrome in bulldogs and French bulldogs Bulldog Everted Laryngeal Saccules

Bulldog Everted Laryngeal Saccules surgically removed by Dr. Kraemer

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING#4: Over time, bulldogs and French bulldogs with this syndrome will develop other secondary problems that further obstruct airflow. They include very large obstructive tonsils and end-stage collapsed atrophied larynx cartilages.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING #5: In the long term, the increased effort associated with breathing can put an increased strain on the heart with heart disease and failure as a possible complication.

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs WARNING #6: Vomiting and gagging are common to the brachycephalic breeds (bulldogs) due to increase in a vagal tone which is a direct outcome of the breed excessive upper airway pressure. This increase in vasovagal tone will further intensify in bulldogs with the brachycephalic syndrome (such as stenotic nares and elongated soft palate).

Gagging and vomiting could lead to aspiration of the vomit content with Aspiration Pneumonia the most likely outcome. Pneumonia could have dire consequences and could be deadly particularly to one going under anesthesia.

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