Gradually Suffocating: Collapsed Trachea in Dogs

When the disease is advanced or when medical treatment has failed, then surgery can be recommended. Learn more about treatment options here.

By: macskafarok
Certain breeds are susceptible to a collapsed trachea. Photo: macskafarok

Small dogs (and rarely cats) can have a specific type of cough caused by a condition called tracheal collapse. The cough is best described as “honking like a goose.”

This can be so severe that affected pets can barely breathe. The more advanced the disease, the less the dog is able to exercise.

Many small-breed dogs suffer from this condition.

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To understand the 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.

Collapsed Trachea in Dogs

Tracheal collapse (also known as collapsed trachea or collapsing trachea) is the narrowing of the windpipe that prevents the dog from getting enough oxygen and from getting rid of heat effectively.

The disease is caused by a defect in the cartilage rings that support the windpipe. Instead of being round, the cartilage rings become flatter and flatter. As they become flatter, the trachea collapses more and more, and the dog suffocates progressively.

There are 4 stages in the progression of the disease, from mild to severe (from Stage 1 to 4). Stage 1 means the dog is mildly affected, and Stage 4 describes the dog who is frequently in respiratory distress or discomfort.

The condition is partially genetic, as the most commonly affected breeds are Yorkies, Miniature Poodles, Pomeranians, Chihuahuas, and other small and toy breeds. Brachycephalic breeds are also at risk.

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Therefore, pets with the condition should be spayed or neutered to prevent spreading the bad genes to the next generations.

Collapsing Trachea in Small-Breed Dogs
Collapsing trachea in small-breed dogs is the narrowing of the windpipe that prevents the dogs from breathing easily. Photo: skeeze

Diagnosis

The classic symptom 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.

To confirm the diagnosis, and determine the stage of the disease, tracheoscopy or fluoroscopy is required.

  • Fluoroscopy is a fancy X-ray that allows the veterinarian to watch inside your pet in real time. You can literally see the trachea move and collapse as the dog breathes. If an X-ray is like a picture, fluoroscopy is like a movie.
  • Tracheoscopy involves looking inside the trachea with a tiny camera under general anesthesia. It is considered the best technique.

This video shows a Pomeranian exhibiting a cough caused by tracheal collapse:

Medical Treatment

Most of the time, the first step in helping dogs with tracheal collapse is medical, or conservative.

Lifestyle changes help, including weight reduction for the overweight animal, air conditioning in hot or humid weather and limiting exercise.

Being overweight makes breathing more challenging for dogs. If that is the case, a weight loss program is mandatory.

Because these dogs can’t exercise safely, we need to work even harder on giving a weight loss diet and not spoiling them with treats and people food.

Depending on how advanced the disease is, most dogs can be helped with medical treatment including steroids, cough suppressants, bronchodilators, tranquilizers and antibiotics.

In an emergency situation, the family or emergency veterinarian would use the same medications in addition to life-saving oxygen.

Small and toy dog breeds are most affected by severe collapsing trachea. Photo: Purplehorse

Surgical Treatment of Collapsed Trachea in Dogs

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.

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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.

External stents are plastic rings that are stitched to the outside of the windpipe. In effect, the stents pull the trachea outward and open it up to allow the dog to breathe. This is a delicate and invasive surgery that has worked over the years but can fail.

Frustrated and creative surgeons invented a revolutionary concept a few years ago: internal stents. These are fancy, expandable, ultra-light cylinders of different lengths and diameters to fit any size dog. The stent is made of metal alloys, mostly titanium.

The beauty of an internal stent is that it is placed without any incision.

It is a noninvasive procedure performed under fluoroscopy. Although the technique is not quite fail-proof, it is elegant.

This procedure is available only at university and specialty hospitals with a qualified group of veterinarians trained in the 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. Again, the stinting itself is minimally invasive, so 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’s 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.

Surgical Success Rate

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 help improve the lower airway disease, but dogs may still exhibit coughing and gagging. Improvement in symptoms, not a cure, is the goal.

Complications of the Surgery

This procedure has been constantly improving over the past 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. Consider traveling to a center with a full team and a long track record.

Most patients stay 1–2 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 $4,000 to $5,000, but it’s more expensive in metropolitan areas like Chicago and New York.

Specialized canine tracheal stents have been around for only about 10 years. They have improved dramatically in that time.

We 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.

Final Thoughts on Collapsed Trachea in Dogs

Overall, collapsed trachea is a stressful disease.

With proper treatment, though, affected dogs can go back to a happy life.

vet-cross60pThis pet health content was written by a veterinarian, Dr. Phil Zeltzman, DVM, DACVS, CVJ, with contributions from another veterinarian, Dr. Debora Lichtenberg, VMD, as well as Kelly Serfas, a certified veterinary technician. This article was reviewed for accuracy by Dr. Pippa Elliott, BVMS, MRCVS, and was last updated Aug. 15, 2019.

If you have questions or concerns, call your vet, who is best equipped to ensure the health and well-being of your pet. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. See additional information.
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