Understanding Brachycephalic Airway Syndrome in Dogs

If you’ve got a flat-faced dog like a Bulldog, French Bulldog, or Pug, you might have noticed some breathing struggles. That snoring at night, difficulty keeping up on walks, or exaggerated panting in mild weather could be pointing to brachycephalic airway syndrome (BOAS). BOAS is a group of airway abnormalities that can make every breath harder for your dog, and it’s worth understanding, because it can progress over time if left unmanaged. The good news is there’s plenty you can do to help.

What is brachycephalic airway syndrome?

Brachycephalic airway syndrome (BOAS) refers to a group of breathing issues caused by the unique facial structure of brachycephalic (flat-faced) dog breeds. Because these dogs have short skulls, their airways are often compacted, leading to physical obstructions that make breathing more difficult.

There are several anatomical abnormalities that contribute to BOAS. The two primary ones are:

• Stenotic nares: Narrowed nostrils that restrict airflow right from the start.
• Elongated soft palate: Soft tissue at the back of the mouth that’s too long and partially blocks the airway.

Some dogs also have a hypoplastic trachea, a windpipe that’s smaller than normal, which adds to the breathing challenge. As BOAS progresses, a secondary change called everted laryngeal saccules can develop, where tissue inside the voice box gets pulled inward from the ongoing effort of breathing, worsening the obstruction further.

If BOAS progresses without intervention, it can lead to secondary complications like laryngeal collapse, or gastrointestinal issues caused by the stress of labored breathing. Early action can help prevent these outcomes and improve your pup’s quality of life.

Signs of BOAS in dogs

The symptoms of BOAS can range from mild to severe, but they’re often hard to miss if you know what to look for:

• Loud snoring or snorting, even while awake
• Labored or noisy breathing
• Exercise intolerance, where your dog gets tired or out of breath quickly
• Open-mouth breathing
• Gagging or regurgitation
• Cyanosis (blue-tinged gums), especially during or after activity
• Difficulty in hot weather (heat intolerance)
• Sleep apnea

If you’re noticing symptoms like these, it’s time to get in touch with your vet. Don’t ignore signs like blue-tinged gums or severe panting. These can indicate a serious issue that needs immediate attention.

Why does BOAS happen?

BOAS happens because the facial structure of flat-faced breeds leaves less space for their airways to function properly. In short, the features that make these breeds so adorable also create unique challenges. Over time, these structural issues can be aggravated by things like obesity, age, or hot weather.

Brachycephalic breeds most commonly affected include:

• Bulldogs and French Bulldogs
• Pugs
• Boston Terriers
• Shih Tzus
• Boxers
• Cavalier King Charles Spaniels
• Pekingese
• Chow Chows

How is BOAS diagnosed?

Your vet will start with a physical exam and a detailed history of your dog’s symptoms. They’ll likely recommend sedation to get a closer look at your dog’s airway and might use imaging like chest X-rays to check for issues like a hypoplastic trachea. BOAS is often graded on a severity scale (0–3), which helps guide treatment options.

How is BOAS treated?

Treatment depends on how severe your dog’s case is. For mild cases, management strategies like weight control, avoiding hot weather, and using a harness instead of a collar can go a long way in relieving symptoms. However, moderate to severe cases often require surgical intervention.

• Rhinoplasty: Surgery to widen stenotic nares and improve airflow.
• Staphylectomy: Trimming an elongated soft palate to keep it from blocking the airway.
• Removal of everted laryngeal saccules: Prevents further airway obstruction.

Surgery not only makes it easier for your dog to breathe but can prevent progression to more severe complications. Most vets recommend addressing BOAS surgically in young dogs, ideally before the age of 2, when outcomes tend to be significantly better.

For late-stage issues like laryngeal collapse, more complex surgical interventions might be required, though outcomes can be less predictable.

Does pet insurance cover BOAS?

Yes. BOAS is covered under Lemonade Pet’s base accident and illness policy, as long as it isn’t pre-existing. That includes eligible costs like diagnostic testing, surgery, and follow-up care that’s often part of treatment for this condition.

One thing worth knowing: BOAS is common in brachycephalic breeds, dogs with short, flat faces like Bulldogs, Pugs, and French Bulldogs. If your dog is already showing symptoms of BOAS, that may affect eligibility for coverage of the condition. Getting a policy in place while your dog is young and symptom-free is the best way to make sure it’s covered.

And if BOAS does end up being considered pre-existing, a policy can still cover a wide range of other illnesses and accidents; everything from infections and digestive issues to injuries and other conditions that come up over the course of your dog’s life.

Before we go

BOAS doesn’t have to limit your dog’s life. Whether it’s managing their weight, adjusting their environment, or pursuing surgery, there’s a lot you can do to help them breathe easier. If you’re noticing signs of BOAS, start with a conversation with your vet. A clear diagnosis and a solid plan go a long way.

Frequently Asked Questions

A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of the policies issued, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage may not be available in all states. Please note that statements about coverages, policy management, claims processes, Giveback, and customer support apply to policies underwritten by Lemonade Insurance Company or Metromile Insurance Company, a Lemonade company, sold by Lemonade Insurance Agency, LLC.  The statements do not apply to policies underwritten by other carriers.