Treatment and Prognosis for Brachycephalic Airway Syndrome
Goals of treating BAS
The immediate goals of treating a dog with severe breathing difficulty as a result of brachycephalic airway syndrome (BAS) are to remove the upper airway obstruction and restore a patent airway. This can be done by intubating the dog and placing it under general anesthesia, with oxygen and anesthetic gas being provided mechanically to the animal through the endotracheal tube. An open airway can also be established through a surgical procedure called a tracheostomy. This involves creating an opening directing into the trachea through the neck and inserting a tube to facilitate the free flow of air. Tracheostomies can be performed on an elective or emergency basis. Another goal of treating a dog in extreme respiratory distress due to BAS is to reduce the animal’s stress, anxiety and discomfort, which in turn will help minimize the risk of adverse secondary complications. The long term therapeutic goal is to remove the tissues or structures that are causing the airway obstruction through surgery.
The narrowed nostrils (stenotic nares) associated with BAS can be widened or opened surgically, either using a traditional surgical scalpel or using the more recently developed carbon dioxide laser. Basically, both of these techniques involve surgically sculpting the nasal openings to allow the free flow of air as a dog breathes in and out. An elongated soft palate can be shortened surgically as well, using either a traditional scalpel or a CO2 laser. Everted laryngeal saccules can be removed with a scalpel, a laser or scissors. Unfortunately, there is no reported surgical procedure or technique to correct an underdeveloped trachea or laryngeal collapse, both of which are often present in brachycephalic breeds.
Dogs with BAS should be kept fit and trim. Obese brachycephalic dogs usually suffer much more serious respiratory difficulties than do dogs kept in a good, normal weight. Because hot, humid environments exacerbate this condition, dogs with BAS should be kept out of areas with high ambient temperatures. They also should be kept as stress-free as possible.
Dogs that undergo successful surgical correction of stenotic nares and/or elongated soft palates at an early age typically have a good to excellent long-term prognosis, especially if they do not also have a hypoplastic trachea or secondary complications such as everted laryngeal saccules or laryngeal collapse. If the dog has an underdeveloped trachea, or if it develops secondary complications of BAS, it has a variable prognosis, ranging from poor to good depending upon the nature and extent of those conditions and the amount of upper airway obstruction that they cause. When a brachecephalic dog develops severe and acute breathing difficulties, the situation can rapidly become life-threatening. If that happens, the outlook is guarded. However, the dog may recover fully if medical treatment is sought and administered promptly to reestablish an open airway.