Health issues in brachycephalic dogs

Brachycephalic (flat-faced) dog breeds have become increasingly popular in recent years. Whilst many deem their flat-faced appearance to be a cute and endearing feature, it can have serious consequences for their health and welfare. 


Brachycephalic dogs are prone to a variety of health conditions that limit their lifespan and/or quality of life. It is crucial, therefore, that those taking care of them, have an awareness of the issues they might encounter. 


What is a brachycephalic dog?

Pugs are popular pets and have the brachycephalic conformation.
A pug is a popular brachycephalic breed of dog

The word brachycephalic is taken from ancient Greek and literally means "short-headed". It is used to refer to dog breeds that have been bred to have short skulls and flat faces.


Popular brachycephalic dog breeds include: Bulldogs, French Bulldogs, pugs, Shih tzus, Lhasa Apsos, Pekingese, Sharpeis, Cavalier King Charles Spaniels and boxers.



Health issues

Having a short skull is also associated a number of structural abnormalities of the respiratory tract. This combination of abnormalities is referred to as brachycephalic obstructive airway syndrome (BOAS). More details about these abnormalities is provided overleaf. As well as respiratory issues, these dogs’ anatomical differences also make them to prone to other problems including:

  • Difficulty giving birth naturally: These dogs have small bodies relative to the size of their skulls. This makes it hard for puppies to pass through the birth canal, meaning that >80% of puppies are delivered by caesarean section.

  • Skin and ear infections: Narrow ear canals and skin folds, especially around the face and nose put these dogs at increased risk of skin and ear infections.

  • Dental issues: Flat-faced dogs have a short upper jaw and less space for their 42 teeth than dogs with a normal sized muzzle. This means the teeth can grow at strange angles or overlap, causing food to become trapped and increasing the risk of gum and dental disease.

  • Eye problems: Flat-faced dog breeds have shallow eye sockets and prominent bulging eyes, making them prone to corneal damage and ulceration. They are also prone to eyelid abnormalities including conditions called entropion, ectropion and “cherry eye”.

  • Neurological issues: Neurological issues can occur due to the compressed skull shape and spinal deformities. An example is syringomyelia, a painful condition (particularly common in Cavalier King Charles Spaniels) characterised by fluid filled cavities in the brain and spinal cord.


Brachycephalic Obstructive Airway Syndrome (BOAS)

The short-skull of brachycephalic dogs is associated the following anatomical abnormalities of the respiratory tract:

  • Elongated soft palate. The soft palate sits at the back and roof of the mouth. Strictly speaking it is not elongated in brachycephalic dogs, the skull is just too small to accommodate it. It can dangle in front of the throat and obstruct the flow of air.

  • Hypoplastic trachea. The trachea (windpipe) is a rigid, tube-like structure that runs from the throat to the chest, carrying air to and from the lungs. In brachycephalic dogs, the trachea is narrowed meaning the amount of air that moves in/out with each breath is reduced.

  • Stenotic nares. At rest, dogs breathe through their nose, opening their mouths to pant and get more oxygen when exercising or excited. Flat-faced dog breeds often have small, slit-like nostrils (nares), which make it difficult for air to pass through, even at rest.

  • Everted laryngeal saccules. Small sacs that sit just inside the larynx can become everted, poking out into the airway and obstructing air flow.

The facial features of brachycephalic dogs can make them prone to some health issues.











What do these respiratory issues mean for affected dogs?

Even in the mildest of cases, Brachycephalic Obstructive Airway Syndrome (BOAS) makes breathing more difficult. Affected dogs are less able to exercise, making them more prone to obesity and joint conditions such as osteoarthritis. The condition also makes them more prone to heatstroke.


BOAS is a progressive and lifelong condition. Over time, the additional effort it takes for affected dogs to breathe causes inflammation and swelling of the airways. This swelling restricts airflow even further. In severe cases, the larynx can become weak and collapse.


Episodes of severe breathing difficulties can occur in dogs after exercise, exposure to hot weather, stress or excitement. The dog might become cyanotic (develop blue-ish discolouration of gums and skin) and collapse or faint. In these instances, emergency veterinary intervention is needed.


Whilst becoming the norm for some breeds of dog to display signs of BOAS, it is by no means “normal”. In many cases, dogs require surgical correction of their anatomical abnormalities in order to live a normal life. As such, the British Veterinary Association are calling for action to drive healthier standards, avoid "normalising" of these dogs' issues and to improve their welfare.


Signs of BOAS:

Brachycephalic dogs with these anatomical abnormalities typically show the following signs:

  • Noisy, laboured breathing

  • Snoring, snorting

  • Excessive panting

  • Retching, gagging

  • Regurgitation, vomiting

  • Difficulty exercising, tiring easily

  • Collapse, syncope (fainting)

  • Sleeping difficulties, sleep apnoea

  • Poor heat tolerance, heatstroke


Tips for taking care of a brachycephalic dog

When taking care of a brachycephalic dog, it is important to be aware of the signs of Brachycephalic Obstructive Airway Syndrome (BOAS). You should also remember they show the dog is suffering some difficulty in breathing and try not to "normalise" them. ​


Taking some precautions can reduce the risk of affected dogs having an episode of severe breathing difficulty and collapse, and to keep them in better overall health:​

  • Exercise the dog within their limits; avoid over-exercising them and provide opportunities for them to slow down or rest if needed​

  • Use harness for walks; pressure placed on their neck by collars and leads can further restrict airflow​

  • Avoid stress or too much excitement; this can trigger a collapsing or fainting episode​

  • Avoid heat; be extra cautious of heatstroke in these dogs and take proactive measures to keep them cool​

  • ALWAYS get any concerns about their breathing, checked out by a vet. Even mild respiratory infections can rapidly cause these dogs to struggle to breathe. ​

  • Do not overfeed them; obesity makes breathing difficulties and skin issues worse​

  • Ensure they are fed a good, well balanced diet to help avoid obesity and prevent dental disease; brush and regularly inspect their teeth​

  • Look out for any signs of eye discomfort (redness, swelling, weeping, pawing or rubbing the eye); get any issues checked out by a vet​

  • Keep skin folds clean; regularly inspect them for signs of soreness or irritation​


What else can pet professionals and businesses do?

Among the veterinary profession, there is a concern that the rapid rise in popularity of brachycephalic dogs is leading to a population-wide increase in ill health and compromised welfare in these breed types. Sadly not all breeders of these breeds of dog are as responsible as we would like, and not taking steps to ensure the brachys they breed have a good conformation.


All pet professionals, whether vets, dog walkers, trainers or groomers, have a responsibility to act as advocates for animal welfare. For example, you might:

  • Help to reduce the negative health and welfare impacts of brachycephaly on dogs in your care by taking the steps outlined above​

  • Engage current and prospective owners in open discussion to:​

  • Raise awareness of the health issues and welfare impacts ​

  • Endorse and spread key messages provided by key stakeholders, e.g. the veterinary profession and welfare organisations​

  • Think carefully about the imagery you use on your promotional material, websites and/or social media, avoiding the use of imagery depicting brachycephalic dogs with poor conformation.​

​For more information, check out:

The British Veterinary Association policy on brachycephalic dogs here.

The Kennel Club information on what they do for these breeds here.

The BVA "breed to breathe" campaign info here.



The information contained in this article is for general information only. Always get any concerns about a dog's health, checked out by a vet.

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