Tracheal collapse is a degenerative, progressive and, more than likely, genetic condition in dogs that primarily affects the Chihuahua, Lhasa Apso, Pomeranian, Shih Tzu, Toy Poodle, and Yorkshire Terrier.
What is tracheal collapse?
Two types of tracheal collapse have been identified.
Traditional – The trachea (windpipe) has horseshoe-like cartilage rings that maintain its structure. Eventually, they start to lose strength and flatten. The rings morph from a bowl shape to a gravy boat. Signs typically start between the ages of four and fourteen. The level of degeneration is graded between 1 (25% collapse) and 4 (90% collapse). Studies have illustrated that dogs with tracheal collapse have decreased amounts of proteoglycans, glycosaminoglycans and glycoproteins.
Malformation – Present primarily in younger Yorkies. Instead of soft cartilage, it is a hard piece of cartilage that is always static/less flexible.
The collapse can cause a dry cough, labored breathing, wheezing, gagging, retching, or vomiting. The most common telltale sign is a ‘goose honk’. These signs can be episodic and induced in times of anxiety, stress, excitement, post-meal, in hot and humid temperatures, or from a constriction such as a collar. In some dogs and due to the level of degradation of the rings, labored breathing and other signs can become constant.
It is important to note that tracheal collapse is not classified or considered a part of the brachycephalic obstructive airway syndrome (BOAS) complex even though some of the afflicted breeds are considered brachycephalic. Tracheal collapse can be secondary or caused by a BOAS condition.
Tracheal hypoplasia is associated with BOAS. This condition is most commonly diagnosed in English Bulldogs. It involves a narrow trachea and generally entails overlapping cartilage rings.
In summary, tracheal collapse: rings do not encircle the trachea and start to degenerate over time. Hypoplasia: narrow trachea. Both conditions can make breathing difficult.
Tracheal collapse is typically diagnosed with radiography or fluoroscopy (real time moving images).
Medical Management, Surgical Management and Stents
Chick Weisse, VMD specializes in interventional radiology and endoscopy at Schwarzman Animal Medical Center (SAMC). He gave an objective presentation a few years ago about symptoms, medical management, surgery, stents, and potential complications. We would encourage anyone who is interested in tracheal collapse to watch it. The video can be found in the middle of the webpage titled “Tracheal Collapse in Dogs”. We provide a snippet of the information he covers below.
Medical Management – Conventional medication management involves antitussives (cough suppressants), anti-inflammatories (corticosteroids like prednisone), antimicrobials (antibiotics), bronchodilators, anxiolytics (anti-anxiety) or sedatives.
A veterinarian may prescribe one or several depending on the companion dog’s condition.
Corticosteroids for the management of tracheal collapse (and many other conditions for that matter) are an increasingly unpopular choice. They increase the risk of bacterial infection, the respiratory rate, and induce weight gain.
Antibiotics should not be prescribed until a culture is taken to ascertain the presence of a bacterial infection.
Bronchodilators might help, but could also be harmful.
For alternatives or complements to conventional medical techniques, researchers at Chiang Mai University in Thailand have been studying acupuncture and certain polyunsaturated fats to improve the quality of life for dogs with tracheal collapse. Definitely be on the lookout for more studies from them.
Surgical Management – Extraluminal ring prosthetics are placed around the trachea. This is typically only for cases with refractory, unresponsive, or severe tracheal collapse.
Stents – Endoluminal stents are not considered surgery and are noninvasive. A stent is placed inside the trachea to maintain structure and airflow.
Dr. Weisse and the veterinary team at SAMC gather and provide a wealth of information on the state of the patient at presentation, as well as short-, mid- and long-term medical management and stent outcomes of patients. While many retrospective analyses are available, those are finite. SAMC, on the other hand, continuously updates its database and shares it with the public and veterinary community.
To emphasize, SAMC’s information is invaluable and needed about tracheal collapse. However, limitations of the data are that it based on SAMC’s patient information and the majority of cases are referrals. Dr. Weisse primarily attends to dogs that have severe cases of tracheal collapse and are already medically managed.
What about the dogs that may have intermittent bouts of ‘goose honking’, and are medically managed by a veterinarian or companion pet parents learning how not to trigger a potential episode? Veterinarians can diagnose between a reverse sneeze, which can also produce a honking noise, and tracheal collapse. Additionally, we could not find any research studies identifying suspected genes or longitudinal studies that investigate disease progression.
Managing Tracheal Collapse
The majority of veterinarians – conventional, integrative and holistic – agree on the following tracheal collapse management techniques.
#1. Harnesses only!
Collars constrain the trachea and can also contribute to thyroid and salivary gland damage.
#2. Weight Control
Additional pounds or ounces cause respiratory distress because hauling weight around requires a higher level of exertion. So, please keep your companion dog (and yourself) slim. Many pet parents may struggle with this point if their companion dogs require exercise restriction or are taking corticosteroids prescribed to dampen the inflammation as they often cause weight gain. Definitely work with your veterinarian or animal nutritionist on a weight loss plan. We also provide a guideline on calculating the caloric amount your companion dog needs to safely lose weight.
We (Dr. Dodds) always suggest a thyroid check as obesity or recent weight gain can be a symptom of hypothyroidism. So, if you can control the hypothyroidism with medication, the weight may come off more easily. Please note that tracheal collapse is not usually secondary to hypothyroidism. The goal is to control the weight with food caloric restriction, and annual thyroid screens.
#3. Stress Reduction/Anxiety Control
It’s very important that the caregiver or others be taught what to do to calm the panicked dog (and person) when a stress-related “attack” occurs. Pet Rescue Remedy should be applied in the mouth plus lavender aroma therapy (dab on nose, behind both ears, and on harness). Lavender aroma spray, essential oil or sachets can be spread around the home as well.
Anxiety is also highly linked to thyroid deterioration. Again, we recommend an annual thyroid screen to help manage the thyroid and to minimize any thyroid dysfunction – related coughing attacks.
#4. Immune Support
A healthy immune system allows the body to fight off infection and please avoid antibiotics as much as possible.
Chondroitin sulfate works in conjunction with glucosamine to reduce joint and other tissue inflammation, to slow the deterioration of cartilage (the building block of the trachea), and stimulate cells found in cartilage (chondrocytes). Make sure the companion dog does not have a food sensitivity to any of the ingredients in these supplements, as most are made from shellfish.
#6. Moisture Rich Diet
Dogs often swallow kibble whole. Kibble is also hard to digest unless it is first moistened and softened. This combination may lead to retching or gagging, which may provoke coughing. It can also predispose to aspiration pneumonia, if any food gets into the trachea during the coughing. We strongly encourage feeding canned, reconstituted freeze dried or dehydrated, home cooked or raw diets as they pass more easily down the esophagus.
#7. CPR & Heimlich Maneuver for Dogs
Most importantly, please learn CPR and the Heimlich Maneuver for dogs as a coughing attack from tracheal collapse can be fatal.
Chueainta, Phurion et al. “Acupuncture Improves Heart Rate Variability, Oxidative Stress Level, Exercise Tolerance, and Quality of Life in Tracheal Collapse Dogs.” Veterinary sciences vol. 9,2 88. 18 Feb. 2022, doi:10.3390/vetsci9020088, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8875848/.
Dodds, W. Jean. “Putting It into Action: Companion Pet Caloric Needs for Ideal Target Weight.” Hemopet, Feb. 4, 2022, https://hemopet.org/putting-it-into-action-companion-pet-caloric-needs-for-ideal-target-weight/.
Mektrirat, Raktham et al. “Polyunsaturated Fatty Acid EAB-277® Supplementation Improved Heart Rate Variability and Clinical Signs in Tracheal Collapse Dogs.” Frontiers in veterinary science vol. 9 880952. 14 Jul. 2022, doi:10.3389/fvets.2022.880952, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9330478/.