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:

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.


BAOS makes it difficult for dogs to suck in a lungful of air.

There is anatomical narrowing at the nostrils, the back of the throat and in the windpipe itself. 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:


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.


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 veterinarian must examine the back of a dog’s throat to see how crowded it is.


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.


  • “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. It was last reviewed Nov. 7, 2014.

Dr. Pippa Elliott, BVMS, MRCVS

View posts by Dr. Pippa Elliott, BVMS, MRCVS
Dr. Pippa Elliott, BVMS, MRCVS, is a veterinarian with nearly 30 years of experience in companion animal practice. Dr. Elliott earned her Bachelor of Veterinary Medicine and Surgery from the University of Glasgow. She was also designated a Member of the Royal College of Veterinary Surgeons. Married with 2 grown-up kids, Dr. Elliott has a naughty puggle called Poggle, 3 cats and a bearded dragon.

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