The Problem With Pugs: Brachycephalic Syndrome

Dogs with brachycephalic syndrome have noses that cause all sorts of breathing problems thanks to tiny nostrils, narrow windpipes and long, soft palates.

By: Яick Harris
What’s not to love about cute Pugs and other flat-nosed dogs? Sadly, their airways are the problem. By: Яick Harris

What’s not to love about a Pug?

The breed is a pet crush of mine, and yet the answer to the question “What’s not to love?” sadly is their airways.

Pugs are a classic example of a breed suffering from brachycephalic syndrome, also known as brachycephalic airway obstruction syndrome — or BAOS, for short.

You will have seen, and definitely heard, dogs with BAOS because you can hear their snoring and snorting even from a different room.

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:

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.

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


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.

Not surprising, then, that these dogs often breathe noisily with sounds ranging from heavy breathing to honking.

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. They almost certainly snore when asleep.

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:

YouTube player


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 Animals Are Affected

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 .

Among all the other conditions that affect brachycephalics more than the general canine population are eye problems (corneal ulcers top the list) and chronic skin conditions.

Other things that can render these dogs miserable:

  • 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, anal gland issues, fungal skin disease, cystitis, skin cancer and pneumonia. No wonder a pet insurance company is inspecting the data on these breeds.

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.

Our hearts break for our frequent-flyer Pugs and English Bullies who are in the office every other month for another problem; for our Pekingeses’ suffering through another eye ulcer; for our itchy Shih Tzus who 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.”

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.

Brachycephalic breeds tend to be a popular choice of pet. By: karygrabovski

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.

So, our best advice to everyone — but particularly people who have brachycephalics:

  • 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 of 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.

Bulldogs are just one of many breeds at risk of complications related to brachycephalic syndrome. By: danielsfotowelt

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.


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

These include resecting, or cutting back, the soft palate to shorten it. Some specialists also do a tonsillectomy to remove tonsils as a source of narrowing.

There are also corrective operations that can widen the nostrils, done with the intention of opening up the airway to make it easier to breathe. However, the narrow windpipe is a problem that can’t be fixed.


In the past couple of centuries, continual selection for snub-nosed dogs, such as Pekingese and Pugs, as well as cat breeds, such as 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.


  • “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.


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 Dec. 17, 2018.