Tracheal Collapse in Dogs
“My dog won’t stop coughing, and I’m not getting any sleep!” What veterinarian hasn’t heard this complaint? Several disorders can cause coughing in dogs. One at the top of the list, particularly in smaller breeds, is called tracheal collapse (aka, collapsing trachea).
The normal trachea
The trachea, also known as the windpipe, transports air from the nose and mouth down into the lungs, then back out again. It’s made up of rings of cartilage, aligned side by side to maintain a smooth cylindrical shape that creates minimal resistance to airflow. Visually speaking, the trachea looks like a corrugated culvert pipe that you’d find at a building supply store.
The entrance to the trachea is the larynx, a cartilage structure that opens during breathing and closes during swallowing. This clever design prevents inhalation of food material into the lungs (aspiration pneumonia).
The inside lining of the trachea contains millions of cilia, fine little hairs that trap inhaled particulate matter. Using a coordinated sweeping action, the cilia then transport these particles, often embedded in mucous, up to the throat for disposal by coughing or swallowing.
Tracheal collapse
Imagine the normal, semi-rigid, “O” shaped tracheal cylinder collapsing in on itself, resulting in a “C” shaped internal lumen. This is tracheal collapse. It’s problematic, not only because of impaired airflow in and out of the lungs, but also in terms of removal of inhaled debris.
The actual collapse is usually a dynamic process—more pronounced during inhalation or exhalation, depending on which portion of the trachea is affected.
Dogs at risk
An inherited defect in the tracheal cartilage is thought to be the major player in the development of tracheal collapse. Small breed dogs are the “poster children” for this disease, particularly Yorkshire terriers, pugs, Pomeranians, poodles, and Chihuahuas. Middle-aged and older dogs are more commonly affected. Overweight dogs and those who live in households are at greater risk.
Symptoms
Tracheal collapse invariably causes coughing that’s often described as sounding like a “goose honk.” However, the cause of a cough cannot be diagnosed based on the sound of the cough, and tracheal collapse is no exception.
Tracheal collapse coughing often worsens in response to excitement, activity, or exercise (when air is moving more vigorously through the trachea) and when exposed to smog, smoke, increased temperature, humidity, and airway allergies.
The cough may be persistent or intermittent. There may be audible wheezing, particularly during inspiration. At its worst, tracheal collapse causes labored breathing, purple or blue-colored tongue and gums caused by oxygen deprivation, and syncopal (fainting) episodes.
Making the diagnosis
The first step is to take X-rays (neck and chest) of the trachea. Given that the collapse may be associated with just inhalation or exhalation, a plain X-ray can miss the diagnosis. For this reason, fluoroscopy (an X-ray but shot in movie mode) is the ideal diagnostic tool.
Tracheoscopy (viewing the inside of the trachea with an endoscope) may be recommended to confirm the diagnosis and gather samples to rule out an underlying respiratory tract infection.
Management tools
While there is no cure for tracheal collapse, there are multiple management strategies for minimizing the coughing and maintaining a good quality of life. Realistically, it’s often difficult to eradicate the coughing altogether.
Lifestyle changes
Weight loss can make a positive difference for obese dogs with tracheal collapse.
It’s a no-brainer that a dog with tracheal collapse and cigarette smoke exposure has a lot to gain by lifestyle changes made by their beloved humans.
Avoidance of known environmental factors that precipitate coughing (heat, humidity, smog, etc.) can make a big difference.
Replacing a neck collar with a chest harness eliminates external pressure on the trachea.
Medications
It’s almost always necessary to rely on medications when managing dogs with significant tracheal collapse symptoms. For some dogs, only short-term or intermittent use is needed. Other dogs thrive only with long-term, if not lifelong, medication.
Antitussive therapy (cough suppression): For dogs with a collapsing trachea, coughing tends to beget more and more coughing. And once a vicious coughing cycle begins, it can be difficult to interrupt. Often, more than one antitussive medication is tried to find just the right recipe to quiet the cough.
Control of secondary inflammation: Anti-inflammatory medications are used to control the inflammation associated with tracheal collapse. Until the inflammation settles down, it can be difficult to control the coughing.
Treatment of secondary bacterial infections: Antibiotics are commonly used to treat possible infection.
Sedation and/or reduction of anxiety: Severely affected dogs may suffer from chronically interrupted sleep and/or anxiety induced by constant coughing and labored breathing.
Oxygen therapy
In severe cases of tracheal collapse, a day or two spent in an oxygen cage may help the dog turn a corner. Such oxygen therapy requires access to a 24-hour hospital and round-the-clock supervision.
Tracheal stents
When medical treatment fails to restore a good quality of life, placement of a tracheal stent might be considered. The stent, made of a metallic alloy, is placed within the area of tracheal collapse. Once deployed, the stent expands to support the tracheal walls. While this procedure can make a positive difference in severe cases of tracheal collapse, not every dog is an ideal candidate. There can be problems associated with anesthesia and complications caused by the stent.
Surgery
Surgical techniques involve placement of support rings around the outside trachea. The goal is to provide structural support. This is an aggressive procedure that can be fraught with complications. With the increasing popularity of tracheal stents, this type of surgery has, for the most part, fallen by the wayside.
Prognosis
The prognosis for dogs with tracheal collapse varies from excellent to awful. The outcome depends on the degree of collapse, which portion(s) of the trachea is involved, and the dog’s individual response to medication.
Veterinary specialists
If your dog develops tracheal collapse, a veterinary internal medicine specialist might just become your dog’s new best friend. The more finesse and experience a veterinarian has using medications to treat tracheal collapse, the greater the likelihood of a positive outcome, particularly in severely affected dogs.
Have you had a dog with tracheal collapse? If so, what worked and what didn’t?
Best wishes to you and your four-legged family members for abundant good health,
Dr. Nancy
Good info for folks with the little ones!
Sadly, this is a breeder issue which will take generations of pups to eliminate. Gigi, a teacup Yorkie with all of the spunk of the breed times ten, had this advanced condition already affecting her at a year old, Two months after having dental surgery where the esophageal tube anesthesia shredded what was left of her tracheal support, even her lion-hearted soul couldn't catch its breath. She was dead at 4 years old despite the best care possible. There is no cure as Dr. Nancy has pointed out. These dogs cannot be bred and puppy mills don't test or care. This condition wouldn't exist if all breeders had maintained a high level testing and standards. Now this condition is rampant in multiple breeds and mixes who carry the genetic propensity.