Vet Guide 2025: Brachycephalic Airway Obstruction Syndrome in Flat-Faced Dogs – Breeding, Airway, Eyes & Care

I'm Dr. Duncan Houston. If you own a flat-faced (brachycephalic) dog—such as a Pug, Bulldog, Boston Terrier, Shih Tzu, Boxer, or Pekingese—this guide explains how their anatomy affects breathing, eyes, digestion, dental health, and quality of life in 2025 and beyond.

🐾 What Does “Brachycephalic” Mean?

“Brachycephalic” comes from Greek, meaning “short head.” These breeds have a compressed upper face, which, while visually appealing to many, often leads to health compromises. This condition is known as Brachycephalic Airway Obstruction Syndrome (BAOS).

🔹 Airway Issues & Anesthesia Risk

The anatomy of brachycephalic dogs often includes multiple overlapping respiratory problems:

• Stenotic nares: Narrow nostrils restrict airflow. Consider surgical widening after 5 months of age.
• Elongated soft palate: Soft palate hangs into the throat, blocking air and causing snoring/snorting.
• Hypoplastic trachea: Narrow windpipes can complicate anesthesia—chest X-rays before surgery are crucial.
• Everted laryngeal saccules: These throat folds can invert, worsening breathing—but may improve once other obstructions are corrected.

Heat, exercise, or stress worsen airway collapse—always monitor activity, weight, and avoid overheating. Severe cases may require surgery or, in worst-case scenarios, a permanent tracheostomy.

🔥 Gastrointestinal & Swallowing Issues

Increased effort to breathe can cause stomach problems such as acid reflux, delayed emptying, and even hiatal hernia. Managing weight and using medications like proton-pump inhibitors can help—but often resolving airway issues also improves GI symptoms.

👁 Eye & Skin Complications

• Lagophthalmos (incomplete eyelid closure): May require surgery to prevent eye drying and damage—monitor blinking during sleep.
• Nasal fold irritation: Skin folds near the nose can rub the cornea. Keep them clean and consider surgical correction for chronic issues.
• Entropion: In-turned eyelids that rub on the eye. Surgery is needed to prevent corneal ulceration.
• Dry eye (Keratoconjunctivitis sicca): Leads to goopy discharge and eye pigment. Treat early to avoid blindness.
• Eye proptosis risk: Shallow eye sockets can lead to eye displacement from minor trauma—using a harness over a collar can reduce risk. Emergency replacement may be needed.

🦷 Dental & Skin Care

Flat skulls equate to crowded teeth, leading to plaque and gum disease. Begin dental cleaning early and maintain with regular home care and professional care under anesthesia.

Facial folds trap moisture and debris—clean and disinfect regularly to prevent infection.

👶 Breeding & Reproductive Considerations

Brachycephalic females often require Caesarean sections due to difficult births. Pre-breeding health checks—including airway evaluation—are critical. Unexperienced breeders should avoid breeding high-risk individuals.

🩺 Prevention & Ongoing Care

• Choose a puppy with wide, open nostrils.
• Manage weight, avoid overheating, and take care with exercise.
• Use a harness instead of a collar for walks.
• Monitor eye health—check blinking, discharge, irritation, and pigmentation.
• Keep nasal folds clean to prevent rubbing.
• Begin dental care early—regular brushing and professional cleaning.
• Work with your vet to determine if early airway surgery (nares widening, palate trimming) is beneficial.

🏥 When to Call the Vet

Seek veterinary care if your dog has:

• Persistent or loud snoring/snorting, especially after exercise
• Gagging, difficulty breathing, or collapse after excitement
• Poor exercise tolerance or overheating despite mild activity
• Eye discharge, redness, pigment changes, or blinking issues
• Signs of GERD—drooling, retching, regurgitation
• Labored breathing or cyanosis (blue gums/tongue)

🔧 Treatment Approaches

Surgical correction of stenotic nares and elongated palate often relieves both airway and GI symptoms. Everted saccules may not need surgery if obstruction improves. Eye issues (entropion, lagophthalmos) typically require corrective surgery.

Medical therapies may include:

• Anti-aging and inhalation guidelines from the American Veterinary Medical Association
• GERD/gastric support medications (proton pump inhibitors, diet modification)
• Eye lubrication, cyclosporine drops, or antibiotics as needed

Pre-anesthetic assessment with chest X-rays, eye exams, and airway evaluation is essential.

📆 Prognosis & Long-Term Outlook

Early surgical intervention and diligent medical management help most brachycephalic dogs live well-adjusted lives. Intervening before structural abnormalities worsen is key. Monthly dental care and fold cleaning help prevent chronic infections.

Re-breeding should be carefully considered, and breeding only healthy individuals ensures breed improvement over time.

📚 Further Reading & Resources

• American Veterinary Medical Association – brachycephalic travel & care guidelines
• American College of Veterinary Surgeons – BAOS information

Flat-faced breeds bring joy, but require dedicated care and monitoring. If you have any questions or would like to discuss whether your dog might benefit from airway assessment or surgery, don’t hesitate to call your veterinarian.

Dr. Duncan Houston, BVSc