To paraphrase Spider-Man, with great popularity comes great responsibility. Now that French bulldogs are the most popular canines in the United States, owners need to understand their special health issues. Brachycephalic airway syndrome (BAS) can be an especially serious problem. (The name comes from the Greek “brakhu,” or short, and “cephalos,” or head.)

BAS affects not only Frenchies but all dogs with flattened faces. This includes English bulldogs, Pekingese, pugs, Boston terriers, Shih Tzus, bull mastiffs, boxers, Lhasa Apsos and King Charles Cavalier spaniels. Persian, Scottish Fold and Exotic Shorthair cats are prone to it, too.

What Causes BAS?

All these dogs and cats have been bred to have short muzzles and noses. That means their throats and breathing passages are frequently undersized or flattened. This creates three problems:

  • The soft palate becomes elongated, so the tip protrudes into the airway and interferes with the movement of air into the lungs.
  • Stenotic nares are malformed nostrils, either too narrow or collapsing inward during inhalation. The animal thus has problems breathing through its nose.
  • Everted laryngeal saccules occur when tissue in the airway in front of the vocal cords gets pulled into the trachea (windpipe) and partially obstructs airflow.

Some dogs with brachycephalic syndrome may also suffer from other conditions. These include an unusually narrow trachea or collapse of the larynx — the cartilages that open and close the upper airway. Some even experience paralysis of those laryngeal cartilages.

How Can Owners Recognize Signs of BAS?

Dogs with elongated soft palates have a history of noisy breathing, especially when breathing inward. Some retch or gag, often while swallowing. Exercise intolerance, cyanosis (blue tongue and gums from lack of oxygen) and occasional collapses are common, particularly during overactivity, excitement, or excessive heat or humidity.

Obesity aggravates these problems. Many dogs with elongated soft palates prefer to sleep on their backs, probably because that makes soft palate tissue fall away from the larynx. Signs associated with stenotic nares and everted laryngeal saccules are similar. And yes, snoring may indicate a breathing problem, though not always.

How Vets Diagnose BAS

They’ll see stenotic nares immediately during a physical exam. To pinpoint elongated soft palate or everted laryngeal saccules, they’ll need to put the pet under anesthesia. Brachycephalic breeds have thick tongues; it’s hard to see the larynx when an animal’s awake and attempts to restrain the patient and retract the tongue are generally unsuccessful.

When the pet’s anesthetized, the vet can tell if an elongated soft palate extends into the laryngeal opening. The tip of the soft palate and the edges of the larynx are often inflamed. In chronic cases, the cartilage of the larynx becomes inflexible and collapse, narrowing the airway. Your primary care vet may recommend chest X-rays to evaluate the lower airways and lungs.

Surgery: The Only Answer

Soft palate abnormalities should be treated when they cause distress in your pet, become more severe with time or cause life-threatening obstruction. If you see gagging, coughing, exercise intolerance or difficulty breathing, a vet can perform a soft palate resection (staphylectomy) with a scalpel, scissors or CO2 laser, stretching the palate and removing excess tissue.

Laryngeal saccules, if everted, should be removed at the same time. Correction of stenotic nares, if present, helps improve breathing and area also corrected under the same anesthetic procedure.

Significant inflammation or bleeding can obstruct the airway after surgery, making breathing difficult or impossible. Then a vet will perform a temporary tracheostomy, making an incision (or stoma) in the neck into the trachea and inserting a breathing tube, until swelling in the throat subsides enough that the pet can breathe normally.

Permanent tracheostomies can be an option for certain patients. However, many brachycephalic patients have short necks; when they hold their heads down, especially when eating, they’ll obstruct their stomas. Animals with many rolls of skin, such as English bulldogs, do the same.

These skin folds predispose them to moist skin infections, which increases risk of infection of the stoma as well as the risk of pneumonia. Some patients that develop laryngeal collapse also have some degree of tracheal collapse; when that happens, the stoma collapses and won’t let the patient take in enough air.

Charlotte Animal Referral and Emergency is the pet equivalent of a human medical center. CARE offers every type of treatment, from emergency care 24 hours a day, 365 days a year, to board-certified specialty attention after you get a referral from your primary veterinarian. You can take a visual tour of the practice at

Want to receive monthly notifications when we post on our blog? Subscribe here.