Brachycephalic Airway Syndrome in
Bulldogs and French Bulldogs

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs puppies includes stenotic nares, elongated soft palate, hypoplastic trachea and everated saccules

Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs puppies includes stenotic nares, elongated soft palate, hypoplastic trachea and everated saccules

Brachycephalic airway syndrome in bulldogs and French bulldogs is also known as Bulldog Brachycephalic Syndrome. “Brachycephalic” is Latin for short-headed or broad-headed. This 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. The Brachycephalic syndrome in bulldogs and French bulldogs refers to a set of primary upper airway anatomical abnormalities that include: Stenotic nareselongated soft palate, and everted laryngeal saccules. A secondary set of abnormalities include: hypoplastic tracheaoverly enlarged and protruding tonsils and laryngeal collapse. Your bulldog may be affected with a combination of one or more of these abnormalities.

The most common clinical signs of Brachycephalic airway syndrome in bulldogs and French bulldogs include strident respiration that is worsened by exercise or excitement and can also be exasperated by high temperatures. Other symptoms may include coughing, gagging, retching and vomiting. These abnormalities caused by the narrowing of your bulldog’s upper airways can cause increased airway resistance, as well as increase negative intra-airway pressure. If this negative intra-airway pressure exceeds the resistance of the surrounding tissue, collapse, inflammation and edema will occur, which will further narrow the airways and further increase the effort required to inhale. Over time, this vicious cycle can lead to acute hyperthermia (as high as 106f) , hypoxia (Oxygen deficiency), hypnosis (blue purple tongue due to oxygen deprivation), fainting (syncope), asphyxiation, pulmonary edema, heart failure and death.

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

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

Due to the seriousness of bulldogs brachycephalic syndrome and the urgency of early intervention, I always discuss the syndrome during your bulldog very first visit, hopefully when your bulldog puppy is only a few weeks or months old.  I will offer a vocal demonstration of the stridor/Stertor (breathing noise associated with the condition) and provide handouts with text and photos. For a definitive diagnosis of an elongated palate, everted saccules and other laryngeal abnormalities direct visualization of those structures would be necessary. This has to be done under some form of sedation in order to allow the insertion of a laryngoscope.  The diagnoses of stenotic nares in french bulldogs is usually made during the physical exam via a visual inspection and Hypoplastic trachea is diagnosed based on radiographic findings.

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

Stenotic Nares: 

Means narrowed nostrils; the narrowing restricts the amount of air that can flow into the nostrils,this can be surgically corrected by removing a wedge of tissue from the nostrils, to allow improved airflow….Read More

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 air flow and proper breathing. As with the other upper airway abnormalities, narrowing of your bulldog airways can cause increased airway resistance, as well as increase of negative intra-airway pressure. in contrast to common notion it is my experience that Trachea Hypoplasia appears to be tolerated well in bulldogs in absence of concurrent respiratory and heart disease.

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, this bulging prolpased saccules will further obstruct airway flow thus should be surgically removed

Dr. Kraemer’s V4B Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs Maintenance: 

When it comes to brachycephalic airway syndrome , weight control is instrumental in proper bulldog care. Bulldogs with mild symptoms will often show improvement with controlled exercise practiced in combination with avoidance of hot or humid conditions and stress. . 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 the patient’s breathing.

Elongated Soft Palate in Bulldogs (Dr. Kraemer, Vet4Bulldog.com)

Elongated Soft Palate in Bulldogs (Dr. Kraemer, Vet4Bulldog.com)

Dr. Kraemer’s V4B Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs  Rule of Thumb: 

Generally, the more abnormalities present the more severe the symptoms, and the worse the prognoses. And the sooner those abnormalities are corrected (surgery), the better the prognoses.

Dr. Kraemer’s V4B Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs Tips & Warnings: 

TIPS:

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #1(DrKraemers.com): I recommend surgical repair of the elongated palate and/or stenotic naers as soon as your bully reached maturity at about 8 month of age

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #2 (Vet4HeathlyPet.com):  If you cannot afford or have to delay surgical treatment, you should ask your vet for a “Tranquilizer & Anti-Inflammatory emergency kit” to be used in stressful situation before or as soon as you dogs is showing signs of respiratory distress

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #3 (StemCell4Pet.com): 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 cant get to a veterinary hospital, rinse your dog with cool water and place a fan over him/her till the temp drops to 103, dont let it go below 100F.

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #4: 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 the 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

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #5: Bulldog suffering from BCS often gag and vomit, to prevent aspiration (i.e. aspiration pneumonia) of the gag content, gastric juices and food so 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. Second, use a blend diet and mix it with water to form a thick soapy meal. Third, Feed smaller portions at a time and fourth, feed your dog on a step to elevate his upper body, the more vertical the better. last, to decrease stomach acidity and gastric reflex, discuss with your vet daily RX like anti acids (i.e. pepsid-c) as well as and antiemetic’s (anti vomit) medication.

Everted prolapsed saccules in bulldogs. Note the 2 pink obstructive bulges in photo. (Dr. Kraemer Vet4Bulldog.com)

Everted prolapsed saccules in bulldogs. Note the 2 pink obstructive bulges in photo. (Dr. Kraemer Vet4Bulldog.com)

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Tip #6: I recommend a harness rather than neck collar to prevent airflow restriction (all bulldogs)

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs Tip #7: Read my anesthesia & Sedation chapter and recommendations. We have special pre-anesthesia bulldog protocols including anti vomiting, anti stress/anxiety medication, anti-inflammatories, and pain relief. Our protocol is specially designed to minimize the breed related anesthesia risks and maximized post anesthesia recovery safety Finally, To improve lung condition, we always initiate pre-anesthesia airway oxygenation masking your dog for 10 min with 100% oxygen flow.

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs Tip #8 Bulldogs with this syndrome have an increased risk of complications associated with general anesthesia, to evaluate general health I recommend routine pre-anesthetic blood work. Also, Chest x-rays could be taken to evaluate the esophagus (megaesophagus), trachea (Hypoplastic), lungs (aspiration pneumonia), heart (heart disease) and diaphragm (hital hernia). For selected cases we also recommend a ECG screening

WARNINGS:

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs Warning #1: Symptoms are often worse in hot or humid weather.

Dr. Kraemer’s Brachycephalic Syndrome in Bulldogs and French Bulldogs Warning #2: In the early post-operative 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 dangerous part of “bulldog anesthesia” . At my practice we assign a trained technician to seat next to our patient, monitor vitals and make sure he/she is sternal with tongue stretched and pink.

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs Warning #3: This syndrome is directly related to the conformation or breed standard for brachycephalic dogs. I don’t recommend breeding a bulldog who have required surgery to correct airway obstruction.

Bulldog Everted Laryngeal Saccules surgically removed by Dr. Kraemer

Bulldog Everted Laryngeal Saccules surgically removed by Dr. Kraemer

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs and French Bulldogs  Warning #4: Over time, dogs 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.

Dr. Kraemer’s 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 possible complication.

Dr. Kraemer’s Brachycephalic Airway Syndrome in Bulldogs and French Bulldogs  Warning #6: Vomiting and gagging are common to the brachycephalic breeds (bulldogs) due to increase in vagal tone a direct outcome of the breed excessive upper airway pressure. This increase in vagal tone will further intensify in bulldogs with 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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