🐶 Brachycephalic Airway Syndrome in Flat-Faced Dogs: Vet Advice for 2025

By Dr Duncan Houston, BVSc 🩺

Squishy-faced pups like Pugs, Bulldogs, Shih Tzus, and Boston Terriers are full of love and personality. But their flat faces—known as brachycephalic features—can come with serious health concerns. One of the most important is Brachycephalic Airway Obstruction Syndrome (BAOS). If you own a brachy breed, this guide is for you. Let’s dive into what it means, how it affects your pup, and what you can do to keep them breathing easy in 2025 and beyond. 🐾💨

📘 What Does “Brachycephalic” Mean?

The term comes from Greek: “brachy” = short, and “cephalic” = head. These breeds have a shortened upper jaw and nasal passage, but a normally sized lower jaw. This gives them their iconic look—but also leads to anatomical compromises. 😕

🔍 Common Flat-Faced Breeds

• 🐶 Pug
• 🐶 English Bulldog
• 🐶 French Bulldog
• 🐶 Shih Tzu
• 🐶 Boston Terrier
• 🐶 Pekingese
• 🐶 Boxer

Each of these breeds may be predisposed to BAOS, depending on how extreme their facial structure is. Let’s break down what that actually means. 🧠

💨 The Anatomy of Brachycephalic Airway Syndrome

BAOS is caused by multiple anatomical issues that restrict airflow. These include:

1. 🔻 Stenotic Nares (Narrow Nostrils)

The nasal openings are often tiny slits, forcing dogs to breathe through their mouths. This makes panting inefficient and contributes to snorting. Surgery can widen the nostrils after 5 months of age. 🩺

2. 👅 Macroglossia (Enlarged Tongue)

A large, thick tongue crowds the already small airway. This is especially common in Bulldogs and Frenchies. It worsens obstruction and may require intervention in severe cases.

3. 🧵 Elongated Soft Palate

The tissue that separates the nose and mouth can hang into the throat, flapping around and blocking airflow. This is common in all brachy breeds but most serious in Bulldogs. It can be trimmed surgically.

4. 📏 Hypoplastic Trachea (Narrow Windpipe)

The trachea may be abnormally small, especially in English Bulldogs. This can cause dangerous anesthesia risks. X-rays before surgery help determine safety for procedures. 🛑

5. 🎈 Everted Laryngeal Saccules

Extra tissue in the throat can flip inside-out after prolonged panting, blocking the airway. Surgery may be needed, though sometimes it resolves after nostril correction. Pugs are most at risk.

☀️ Why Heat, Stress & Excitement Are Dangerous

Flat-faced dogs pant poorly. Instead of efficiently cooling via evaporation on the tongue, they expend tons of energy just to move air. This causes:

• 🔥 Throat swelling
• 🥵 Overheating
• 😣 Breathing distress

Overexertion in hot weather can be life-threatening. Always watch for signs of heatstroke and avoid stress, long walks, or air travel during summer months. 🌡️

✈️ Travel Considerations

The AVMA has issued special guidelines for air travel with brachycephalic breeds. Many airlines have restrictions due to the high risk of breathing emergencies. Always consult your vet before flying. 🛫🐾

📉 Long-Term Consequences of Untreated BAOS

If left untreated, airway issues can get worse over time, leading to:

• ⚠️ Laryngeal collapse
• ⚠️ Need for permanent tracheostomy (surgically placed breathing hole)
• ⚠️ Chronic fatigue and exercise intolerance

Early correction of nostrils and soft palate can drastically improve quality of life. Prevention is powerful. 💪

🧃 Digestive Tract Side Effects

Struggling to breathe increases abdominal pressure, which leads to:

• 🤢 Acid reflux
• 🤮 Vomiting and regurgitation
• 🍲 Delayed gastric emptying (food sits too long in the stomach)

English Bulldogs are especially prone. Managing weight and correcting airway obstruction often resolves GI issues. Your vet may also prescribe anti-reflux meds. 💊

👁️ Eye Problems in Brachy Breeds

Flat faces = shallow eye sockets = eye risks:

👁️ Lagophthalmos

Eyes don’t fully close during sleep. Causes dryness and irritation. Can lead to blindness without correction. Watch your dog sleep to check! 😴

🧼 Nasal Fold Irritation

Skin between the eyes and nose can rub the cornea, creating dark pigmentation and pain. Often corrected with minor surgery.

↪️ Entropion

Eyelids roll inward, letting eyelashes scratch the eye. Can lead to scarring and ulcers. Surgery may be needed.

💧 Dry Eye (Keratoconjunctivitis Sicca)

Thick, yellow discharge is a red flag. Treated with eye drops and regular checkups to prevent vision loss. 👀

⚠️ Risk of Proptosis

Because the eye sockets are so shallow, trauma (even pulling on a collar) can cause the eye to pop out. Always use a harness instead of a collar! 😱

🦷 Dental Issues in a Crowded Mouth

Brachycephalic dogs still have 42 teeth—but less space! This leads to:

• 🦷 Overcrowding
• 🦷 Angled teeth
• 🦷 Gum infections

Start dental hygiene early. Use dental chews, vet-safe toothpaste, and schedule regular cleanings to avoid surgery later. 🪥

🧽 Skin Fold Infections

Moisture + warmth in facial folds = skin infections. Clean these areas weekly with vet-approved wipes. Look for redness, odor, or black debris. 🚿

🐶 Reproduction Risks

Because of their wide skulls and narrow hips, natural birth is rare. Caesarean sections are often needed. Never breed a brachy dog without vet screening for tracheal stenosis or airway concerns. ⚠️

✅ How to Help Your Flat-Faced Dog Thrive

• 🌡️ Avoid heat and stress
• 🥗 Keep weight in a healthy range
• 🧼 Clean folds and eyes regularly
• 🪥 Start dental care young
• 🩺 Consider early airway surgery if advised
• 📞 Talk to your vet about any breathing, eye, or digestive concerns

📱 Use Ask A Vet for Peace of Mind

Not sure if your pup’s snoring is normal? Need help with cleaning routines or travel advice? 🐕💨 Use the Ask A Vet app to connect with licensed vets from the comfort of home. 🩺📲

Visit AskAVet.com to download and access expert support anytime. 🐾

💬 Final Thoughts from Dr Duncan Houston

Brachycephalic dogs are bundles of joy—but they need a little extra attention. With the right care, many live happy, full lives. Knowledge is your most powerful tool. 💖

Monitor their breathing, maintain a cool environment, and never hesitate to get professional advice. You’ve got this—and your pup is lucky to have you. 🐶👏