What is Brachycephalic Obstructive Airway Syndrome (BOAS)?

Brachycephalic Obstructive Airway Syndrome (BOAS) is a group of upper airway abnormalities commonly seen in short-muzzled (brachycephalic) breeds including but not limited to:

  • French Bulldogs
  • English Bulldogs
  • Boston Terriers
  • Shih Tzus
  • Boxers
  • Pugs
  • Persian and Himalayan cats

These breeds have a compact skull shape that can interfere with normal airflow, leading to respiratory distress, exercise intolerance, and other health concerns. These breeds typically have the same amount of tissue in their muzzle as a dog with normal face conformation but it is compressed into a smaller space. 

Signs Your Pet Might Have BOAS include:

  • Noisy breathing (snorting, wheezing)
  • Exercise intolerance or collapse
  • Heat sensitivity or easily overheating
  • Snoring or restless sleep
  • Gagging, retching, reflux, or regurgitation
  • Cyanosis (bluish gums/tongue)

Components of BOAS:

  • Stenotic Nares - Narrow nostrils that limit airflow
  • Elongated Soft Palate - A soft palate that is too long and distends down into the airway causing resistance to breathing
  • Hypoplastic Trachea - An abnormally small windpipe
  • Everted Laryngeal Saccules - Tissues that protrudes obstructs the airway due to chronic airway resistance
  • Laryngeal Collapse - Advanced, life threatening obstruction. End stage BOAS.

At-Home Management of Dogs with BOAS:

  • Use a harness instead of a collar
  • Avoid heat and overexertion
  • Maintain a healthy body weight
  • Use raised food/water dishes if regurgitation is a concern

While these help reduce symptoms, surgery is the only way to correct the physical causes.

Why Surgical Correction is Recommended:

BOAS is a welfare issue. Excess tissue in the throat predisposes patients to multitude of problems. Because this excess tissue causes resistance to breathing, over time inflammation and swelling of the tissue in the throat ensues, making it progressively harder to breathe and increasing risk of heat stroke, secondary acid reflux/regurgitation, noisy breathing/snoring, etc. The longer this is left untreated the more the condition progresses and becomes increasingly complicated and risky to correct. Over time this can lead to collapse of the airway (laryngeal collapse). 

Surgical Treatment Options Offered at Salish Veterinary Hospital:

  • Stenotic Nares Resection - This procedure widens the nostrils to improve airflow. It is performed with a surgical scalpel or laser depending on the doctor's preference.
  • Elongated Soft Palate Resection - This procedure shortens the soft palate to reduce airway obstruction. It is performed with a surgical laser. Sutures are generally not needed.

These procedures are the best done in a young patient ages 6-18 months. This allows correction of the airways before chronic changes have had time to develop and gives the best chance of benefit from the procedure. When doing an elongated soft palate resection, it should not be combined with any other surgeries (other than stenotic nares resection).

Additional procedures that are less commonly needed to correct BOAS include laryngeal saccule removal, tonsillectomy, and tracheostomy (rare, emergency only). These procedures are only needed when BOAS has advanced over time are referred to a specialty hospital.

Benefits of Surgery May Include:

  • Improved breathing and energy levels
  • Reduced resistance to breathing, which if not corrected over time, causes trauma and inflammation to the tissue at the back of the throat that can result
  • Better exercise and heat intolerance, reduced risk of heat stroke
  • Reduced snoring, gagging, and regurgitation
  • Longer, more comfortable life

Risk of Surgery

  • General anesthesia risks (especially in brachycephalic breeds) such as aspiration pneumonia, or adverse drug reaction
  • Swelling or temporary breathing difficulty post-op that could cause death or require transfer to a 24-hour ER
  • Infection, bleeding, or need for additional procedures
  • May not fully resolve symptoms in severe cases

Most pets show dramatic improvement with surgery and proper recovery.

Precaution taken to help limit risk:

  • For all brachycephalic patients undergoing anesthesia we recommend giving an antacid (omeprazole) and a prokinetic (metoclopramide) 1 week pre and post surgery to help limit risk of regurgitation and aspiration pneumonia. We also recommend giving an anti-nausea medication (maropitant) 24 hours to and for several days after the procedures as well.
  • The patient should be fasted for 18 - 24 hours prior to anesthesia. 
  • Administer sedatives the night before and the morning of procedure.
  • Feed small meat balls of canned post operatively while tissue is healing

Work up to determine if your pet is a candidate for BOAS surgery:

  • Physical exam/Consultation appointment
  • Blood work (CBC/Chem/T4)
  • Pre-anesthetic EKG
  • Radiographs of neck, chest and abdomen that are reviewed by a board-certified radiologist to assess for elongated soft palate, pneumonia, hypoplastic trachea, and hiatal hernia. 

With early diagnosis and appropriate treatment, many brachycephalic pets can live a happy, active, and more comfortable life. If you have any questions, please feel free to contact us here.