August 16, 2023 Dogs Surgery

Ask the Vet: Answers to Your Questions About Brachycephalic Obstructive Airway Syndrome and Collapsing Trachea

Ann Hohenhaus examines a dog

Ask the Vet: Answers to Your Questions About Brachycephalic Obstructive Airway Syndrome and Collapsing Trachea

Every month on Ask the Vet, radio show and podcast I host in partnership with Sirius XM, I answer listener question that come into our email box at This past month I had so many good questions, I could not answer them all and still talk with my guest, AMC’s new President and CEO, Helen Irving. Two of the questions were about common respiratory problems managed by AMC specialists. The questions and my answers can be found below.

Brachycephalic Obstructive Airway Syndrome (BOAS)


Joann from New York City has an eight-year-old show dog and champion pug named Sassy, which she adopted when the breeder retired her. The pug has difficulty breathing – especially in the warmer weather. She says Sassy sounds like a little steam engine. Joann has had six pugs, but none have had this issue. Joann’s vet said Sassy’s windpipes are too narrow and any surgery would be dangerous. Joann has read there is now a laser-type surgery that could help. Is it safe? Effective?


It sounds like Sassy has Brachycephalic Obstructive Airway Syndrome (BOAS), a condition common among pugs, unfortunately. This syndrome occurs from a combination of six different anatomic abnormalities including:

  1. Nose holes that are too small (stenotic nares)
  2. Elongated air filtering bones inside the nose (extended nasopharyngeal turbinates)
  3. Overlong roof of the mouth (elongated soft palate)
  4. Collapsing voice box (laryngeal collapse)
  5. Narrow windpipe compared to dog’s size (hypoplastic trachea)
  6. Pouches inside the voice box that turn inside out and block airflow (everted laryngeal saccules)

It is likely a combination of these abnormalities that makes Sassy “sound like a steam engine.”

At AMC, we have options when it comes to correcting the abnormalities associated with BOAS as we have two surgical options: laser and bipolar cautery. This allows our surgical teams to choose what is best for each patient. While anesthesia is more challenging in dogs with narrow windpipes, AMC’s anesthesia team collaborates with the surgical team to make any surgery as safe as possible for our pet patients.

So, to answer the listener’s question: yes, laser surgery is safe for the correction of BOAS, but discuss your options with a board-certified veterinary surgeon.

Collapsing Trachea


Richard writes that his dog, Peanuts, coughs a lot because of a collapsed trachea. He wants to know if there is a safe, over-the-counter cough suppressant that he can give to Peanuts, something to help stop the coughing.


Collapsed trachea and BOAS are both characterized by noisy breathing, but a collapsed trachea tends to cause a cough that sounds reminiscent of a goose honk. In hot, humid weather, the cough often gets worse, not unlike what Sassy’s owner described in her dog with BOAS. I have two problems with over-the-counter cough medications. First, a lot of them are sticky, cherry flavored liquids that most dogs don’t like. To be effective, over-the-counter cough medications for children need to be given to dogs in large volumes, which further complicates their use. Second, they don’t work very well. This is why veterinarians prescribe narcotic cough suppressants to control the cough associated with tracheal collapse. Narcotic cough suppressants are controlled drugs, which means there are some necessary rules and limitations about prescribing this class of drug. However, veterinarian-prescribed cough suppressants are my recommendation for Peanut.

More Resources on Brachycephalic Obstructive Airway Syndrome and Tracheal Collapse

Tracheal collapse and brachycephalic airway syndrome are such important diseases that AMC’s board-certified surgeons Dr. Chick Weisse and Dr. Dan Spector have given presentations to help dog owners understand these disorders. To learn more about tracheal collapse, read our Pet Health Library entry and watch the video here. To learn more about brachycephalic airway syndrome, read our Pet Health Library entry and watch the video here.

Tags: ask the vet, BOAS, brachycephalic obstructive airway syndrome, collapsed traches, Collapsing trachea, Podcast, tracheal collapse,

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