Many small-breed dogs suffer from a syndrome called collapsing trachea.
To understand this problem, try to visualize the trachea (windpipe); the breathing tube is held rigid by cartilage rings. Think of an empty tube with a slinky toy inside of it to keep it rigid.
That’s a trachea.
With tracheal collapse, the cartilage rings are weakened. Here are the facts:
- Tracheal collapse is the narrowing or flattening of the trachea (windpipe) that prevents the dog from getting enough air (oxygen) to breathe easily.
- There is a genetic predisposition to this syndrome; small and toy breeds are most affected. Pomeranians, poodles, Yorkies and Chihuahuas are overrepresented. Brachycephalic breeds are also at risk.
- Collapsing trachea can be mild to severe. Stage 1 means the dog is mildly affected, and Stage 4 describes the dog who is frequently in respiratory distress or discomfort.
- The classic symptom of this disease is a honking cough. Often, the little patient coughs more with excitement or exercise. There can be a wheeze on expiration. The pup often has to stop what they’re doing to catch their breath, stand still and cough.
- Most dogs can be helped with medical treatment including steroids, cough suppressants, bronchodilators, tranquilizers and antibiotics.
- Lifestyle changes help, including weight reduction for the overweight animal, air conditioning in hot or humid weather and limiting exercise.
Some little dogs are so severely affected that they are constantly coughing or in a degree of respiratory distress. Their quality of life is compromised. Often, they have lived for a long time with a collapsing trachea and have been managed with medications, as mentioned above.
When a dog cannot enjoy a normal daily routine even with limited exercise and medications, their veterinarian may suggest a surgical procedure involving the placement of tracheal stents.
Tracheal stenting is an interventional treatment to alleviate severe tracheal collapse. A mesh-like rigid tube (think of a rigid criss-cross slinky) is placed inside the trachea using advanced imaging techniques such as bronchoscopy, fluoroscopy or digital radiography.
This procedure is only available at university and specialty hospitals with a qualified group of veterinarians trained in this procedure. Often, there is a veterinary team at work that might consist of an internal medicine specialist with a specific interest in respiratory disease, an interventional radiologist, a soft tissue surgeon and/or an emergency critical care specialist.
Dogs Considered for Tracheal Stenting
Typically, the patient is older, since this is a progressive disease, and this procedure is only warranted in severely affected dogs. The little dog should be in generally good health and able to undergo several anesthetic procedures. The stinting itself is minimally invasive, and the hospital stay is usually short.
Many of these small breeds suffer from heart disease or concurrent diseases as well as collapsing trachea, so the patient undergoes a complete health and cardiac workup prior to consideration of tracheal stenting.
Tracheal stents last for a few years. It is difficult to remove or replace them. Specialists try to wait and use stents as a last resort, relying on medical therapies for as long as possible.
The procedure is successful in improving the breathing and quality of life of patients in 75–80% of dogs, reports say. Approximately 5% of dogs show no improvement.
Dogs living with a collapsing trachea for many years usually have chronic lower airway changes. The stents ameliorate the lower airway disease, but dogs may still exhibit coughing and gagging. Improvement in symptoms, not a cure, is the goal.
This Yorkie suffers from a partially collapsed trachea:
This procedure has been constantly improving over the last decade. Acute complications and infections are rare. Most of the problems are associated with the stents breaking or migrating (moving from the original placement) after a few years. Inflammation can also occur through the stent, and collapse can occur at the end of the stents.
Specialists report that some dogs have stents for 5 years without complications, but this is the exception rather than the rule. Experts interviewed suggested that stents have an average life of 2 years; removing or replacing them is risky.
Tracheal stenting does not take the place of medical management. Most of these dogs remain on some drugs to help with their respiratory issues even after the stents have been placed.
Cost and Availability
Although more and more specialty hospitals are cropping up every year, this is still an uncommon procedure. It is strongly advised, if referred for tracheal stenting, to ask about the experience of the team, its success and complication rates. I would suggest traveling to a center with a full team and a long track record.
Most patients only stay 1 or 2 nights in the hospital. This is an ICU situation with oxygen cages and 24-hour monitoring. If no complications occur immediately post-op, the dog leaves the hospital feeling good, bright and alert.
This is an expensive procedure. Begin with an estimate of $4-5,000. Some surgeons in metropolitan areas like Chicago and New York said the cost was higher in their cities.
Specialized canine tracheal stents have been around for only about 10 years. They have improved dramatically in that time. I suspect the placement of tracheal stents will become more common as the stents continue to improve and the technology and expertise to place them evolves.
This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD. It was last reviewed Feb. 7, 2018.
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