Why, Generally, Short-Nosed Breeds Are at a Higher Health Risk

Getting pet health insurance for these lovable dogs may pay off in the long run.

Bulldogs are just 1 of many breeds at risk of complications related to brachycephalic syndrome. By: danielsfotowelt

You’ve got your pugs, your shih tzus, your lhasas, your Boston Terriers. 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.

Many parents of these precious pups understand their dog may be afflicted to some degree by “brachycephalic syndrome,” or BOAS (brachycephalic obstructive airway syndrome). This is a well-known problem in short-nosed dogs and cats that can lead to varying degrees of difficulty breathing or respiratory distress.

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.

How Brachycephalic Animals Are Affected

A recent study by Nationwide found more worrisome statistics for people with brachycephalic pets. These popular (and some not-so-popular) breeds suffer from many other problems not related to breathing issues and snuffly noses (see breed list below).

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. Painful eyes; annoying, endless, itchy allergies; constant ear problems and recurrent skin infections can render the poor dog miserable.

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.

Think Cavichon, shih-poo, puggle, etc. We now have Rottweilers being crossed with pugs and other short-nosed breeds to get a dog unethical folks call a mini Rottweiler. This is not good.

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

How to Break Some Worrisome News

Trying to tell the human of 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 me, particularly when the pup has cost a lot of money.

Many of these breeds come with an exorbitant price tag. People actually boast to me about the many thousands they just put out for their little 8-week-old cosmopolitan Frenchie or trophy English bull puppy.

So what should my response be to this new and very green-behind-the-ears person? To say the purchase price is just the down payment does not show compassion, even if it’s true. And as a general practitioner, I will not necessarily be the one who will help them work out a financial plan for future vet bills.

These breeds often require referrals to ophthalmologists, dermatologists, veterinary dentists and board-certified surgeons who specialize in surgery of the respiratory tract.

Insure These and All Pets Immediately

My best advice to everone — but particularly people who have brachycephalics — is to get a comprehensive pet insurance policy as soon as they acquire 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 veterinarian notices anything from snuffly breathing to entropion (an eyelid malformation), it is possible that an insurance company might dispute coverage for future treatment for related problems like stenotic nares or corneal ulcers.

A bigger concern of mine 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 purchasing 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.

Is your 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 her corneal ulcer needs surgical repair?

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

Learn more about BOAS in this informative video:

A List of Brachycephalic Breeds

The Nationwide study included 23 breeds. The list may surprise you because they are not all teeny, cuddly pet-store puppies:

  • Affenpinscher
  • Boston Terrier
  • Boxer (the poster-child breed)
  • Brussels Griffon
  • Old English Bulldog
  • Shih tzu
  • Cavalier King Charles Spaniel
  • Dogue de Bordeaux
  • English Bulldog
  • French Bulldog
  • Japanese chin
  • Lhasa apso
  • Mastiff
  • Mastiffs including Brazilian, bull, English, Neopolitan, Pyrenean, Tibetan, Spanish
  • Pekingese
  • Pug
  • Victorian Bulldog

I don’t know why the Chihuahua (apple-faced), chow chow, Tibetan spaniel, toy spaniel and the shar-pei are not on the Nationwide list. They are considered brachycephalic.

I suppose the shar-pei is in a class by itself due to the health problems these dogs face, compounded by some poor breeding. For you rescuers and adopters out there, realize any mixed breed dog with a short snout can be affected by these problems, although probably to a lesser degree.

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.


This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD. It was last reviewed Sept. 27, 2017.

Dr. Debora Lichtenberg, VMD

View posts by Dr. Debora Lichtenberg, VMD
Dr. Debora Lichtenberg, VMD, is a small animal and exotics veterinarian who has split her time between a veterinary practice in Pelham, Massachusetts, and her studio in New York City. Dr. Lichtenberg is a graduate of the University of Pennsylvania School of Veterinary Medicine with 30 years of experience. Her special interests are soft tissue surgery and oncology.

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