Why Pugs Are the Worst: Is Brachycephalic Syndrome Allegedly to Blame?

This pet health content was written by a veterinarian, Dr. Pippa Elliott, BVMS, MRCVS, with contributions from Dr. Debora Lichtenberg, VMD. It was last reviewed on June 21, 2024

Brachycephalic Syndrome in Pugs

Pugs are a classic example of a breed suffering from brachycephalic syndrome, also known as brachycephalic airway obstruction syndrome (BAOS). You will have seen, and definitely heard, dogs with BAOS because you can hear their snoring and snorting even from a different room. This is why pugs are the worst when it comes to health issues related to their airways.

What Is a Brachycephalic Dog?

To understand this condition, you must know what a “brachycephalic” dog is. These are those breeds of dogs with cute childlike faces because they have been bred to have flat noses. Examples of brachycephalic dogs include:

• Pugs
• Bulldogs
• Boxers
• Shih Tzus
• Japanese Chins
• Pekingese

All these breeds with cute-as-a-button pushed-in faces are called brachycephalic, a term used to describe dogs (and cats) with short noses. The genetics for the squat, flat nose cause all sorts of problems with these dogs’ breathing and also predispose them to have tiny nostrils, narrow windpipes, and long soft palates.

The Impact of Brachycephalic Syndrome on Pugs

Many people with these precious pups understand their dog may be afflicted to some degree by brachycephalic airway obstruction syndrome. This is a well-known problem that can lead to varying degrees of difficulty breathing or respiratory distress.

Symptoms of Brachycephalic Syndrome in Pugs

BAOS makes it difficult for dogs to suck in a lungful of air. Their anatomy predisposes them to abnormalities in their nose (stenotic nares), an overlong soft palate, and/or a hypoplastic trachea—any of which can lead to problems in their laryngeal area, making breathing more difficult, particularly during exercise, heat, stress, or excitement.

Common Symptoms Include:

• Noisy Breathing: These dogs often breathe noisily with sounds ranging from heavy breathing to honking.
• Exercise Intolerance: Depending on the severity of the BAOS, these dogs may become distressed even after gentle exercise, and their tongues loll out as they pant desperately trying to catch their breath.
• Snoring: They almost certainly snore when asleep.
• Heat Sensitivity: On hot days, because they struggle to pant, they are at great risk of heat stroke with even small amounts of exercise.

In this video, Dr. Marty Becker, DVM, shares information about the condition:

Why Pugs Are the Worst: Causes of Brachycephalic Syndrome

Brachycephalic dog breeds by their very nature have anatomical problems with their airways that make it difficult to breathe normally. These are:

• Narrow nostrils: The nostrils tend to be tiny and slit-like. Imagine trying to breathe through a bunged-up nose for the whole of your life.
• Long, soft palates: The fleshy part of the palate is designed to stop food from going into the windpipe. However, brachycephalic dogs have a shortened nose, but the soft palate remains the same size. This is like stuffing a gag into the back of their throat, causing them to cough, snort, and choke.
• Large tonsils: Turbulent airflow at the back of the throat generated by the anatomical abnormalities tends to suck the tonsils out of their crypt. They then sit at the back of the throat and further narrow the airway.
• Small windpipe: In another cruel quirk of nature, the gene coding for short noses also reduces the diameter of the windpipe.

How Brachycephalic Syndrome Affects Dogs

A recent study by Nationwide found more worrisome statistics for people with brachycephalic pets. These breeds suffer from many other problems not related to breathing issues and snuffly noses.

Common Problems Include:

• Eye problems (corneal ulcers top the list)
• Chronic skin conditions
• Painful eyes
• Annoying, endless, itchy allergies
• Constant ear problems
• Recurrent skin infections

Completing the Nationwide list of problems more common in the brachycephalic is conjunctivitis (read more), anal gland issues, fungal skin disease, cystitis, skin cancer, and pneumonia. No wonder a pet insurance company is inspecting the data on these breeds.

For further details, you can refer to the Nationwide study on brachycephalic breeds.

Why Pugs Are the Worst: A Vet’s Perspective

Veterinarians have been concerned for years about the multiple problems brachycephalic breeds face, so this study and others like it are no surprise to us. We see these breeds all the time for problems other than respiratory. This is one reason why pugs are the worst when it comes to health issues.

• Our hearts break for our frequent-flyer Pugs and English Bullies who are in the office every other month for another problem.
• Our Pekingeses suffer through another eye ulcer.
• Our itchy Shih Tzus sweetly lick our faces on the exam table while scratching themselves until they bleed.

Because of their winning personalities and cuteness factor, these breeds—particularly the little ones—are among the most popular. Add to that the craze for “designer breeds,” and the health issues compound.

• Cross a dog that is not a brachycephalic, like a Bichon or a Poodle, with one of these short-nosed breeds and you may be in for some of the same chronic health issues.

How to Break Some Worrisome News

Trying to tell someone with a new, insanely cute 2-pound ball of fluff that they may be in for health troubles and expensive vet bills—simply because of the genetics of their new bundle of joy—is not a way to endear that person to the vet, particularly when this puppy has cost a lot of money.

These breeds often require referrals to ophthalmologists, dermatologists, veterinary dentists, and board-certified surgeons who specialize in surgery of the respiratory tract. This is another reason why pugs are the worst when it comes to health issues.

Our Best Advice for Brachycephalic Dog Owners:

• Get a comprehensive pet insurance policy as soon as you get the pet.
• Don’t let the pet insurance companies refuse coverage because your pet has a “pre-existing” condition, which is the biggest and most frustrating minefield people must navigate with pet insurance.
• For example, if you take your new puppy to a vet for a wellness check and the vet notices anything from snuffly breathing to entropion (an eyelid malformation), it is possible that an insurance company will dispute coverage for future treatment for related problems like stenotic nares or corneal ulcers.
• A bigger concern is that insurance companies put coverage limits on certain conditions in certain breeds. Will it be more expensive to get coverage for a breed a company deems a greater risk?
• If you’re buying a Pug, for instance, ask about coverage for BOAS and corneal ulcers. How much of surgery and medical treatment is covered? Then find out how much a referral surgery can run for these conditions.

Other Questions to Ask When Insurance Shopping:

• Is the insurance company in line with what state-of-the-art treatment or recurrent or multiple surgery will cost?
• Is there a cap for coverage in a calendar year or a lifetime?
• What if your pet’s allergies become severe in the same year their corneal ulcer needs surgical repair?

Going in with eyes wide open is better than reading an insurance claim with “Denied” on it.

Diagnosis and Treatment of BAOS in Pugs

Diagnosis of BAOS

In a brachycephalic dog, this is not so much a case of “Does the dog have BAOS?” but rather, “How severe is the BAOS?” To assess this, the vet examines the back of a dog’s throat to see how crowded it is.

For you rescuers and adopters out there, realize that any mixed-breed dog with a short snout can be affected by these problems, although probably to a lesser degree.

Treatment for BAOS

There are a number of surgical procedures that can help, but not cure, BAOS:

• Resecting the Soft Palate: Cutting back the soft palate to shorten it.
• Tonsillectomy: Some specialists remove the tonsils as a source of narrowing.
• Widening the Nostrils: Corrective operations can widen the nostrils to open up the airway and make it easier to breathe. However, the narrow windpipe is a problem that can’t be fixed.

Prevention: Why Pugs Are the Worst in Brachycephalic Breeds

In the past couple of centuries, continual selection for snub-nosed dogs, such as Pekingese and Pugs, as well as cat breeds like Persians, has created respiratory problems.

If you look at paintings of these breeds from the 18th century, you’ll see that their noses were far more prominent then and not as flat as today. This trend needs to be reversed. Perhaps out-breeding Pugs with Beagles would be a start to introduce a healthier length of nose.

In the meantime, happy snorting, you snuggly, bug-eyed, noisy breathers! We love you, and we’ll try to keep you happy and healthy! You are among our sweetest and most loving patients.

Frequently Asked Questions (FAQ)

References

• “Brachycephalic airway obstruction syndrome — A review of 118 cases.” Lorinson, Bright & White. Canine Pract, 22: 18–21.
• “Brachycephalic airway syndrome.” Hendricks. Vet Clin North Am, 22L: 1145–1153.
• “Never Buy a Pug.” PETA. Retrieved from https://www.peta.org/features/never-buy-a-pug/.