Collapsing Trachea in Small Breed Dogs: Signs, Causes, and Management

Collapsing trachea is a common condition in small breed dogs that can cause a dry, hacking cough. It is often triggered by warm weather, pulling on collars, or strong scents. While it is more common in older dogs, it can affect dogs of all ages. In this episode, we discuss the signs of a collapsing trachea in your dog, which breeds are most susceptible to this condition, and what causes it. We also explore how veterinarians diagnose collapsing trachea and the complex factors that contribute to this condition.

If your dog has a collapsing trachea, there are steps you can take at home to help manage their symptoms. Medications such as inhalers, steroids, or anti-anxiety medications can be helpful, as well as removing any irritants like smelly candles, perfumes, or cleaning materials. Using a harness instead of a collar and restricting exercise when your dog is coughing excessively can also help. Listen in as we explore the causes, diagnosis, and treatment of collapsing trachea in small breed dogs.

What You’ll Learn:

• Common signs of a collapsing trachea in your dog.

• Which breeds are most affected by a collapsing trachea.

• What causes a collapsing trachea.

• How veterinarians diagnose a collapsing trachea.

Ideas Worth Sharing:

• “There are a lot of complicated factors that go into a collapsing trachea in your dog, so it is important to know the signs.” - Tyler Sugerman

• “If your dog’s collapsing trachea is not that bad, there are some things you can do at home to help them recover, such as medication like inhalers, steroids, or anti-anxiety medications.” - Tyler Sugerman

• “If you want to minimize your dog’s symptoms, remove any irritants (such as smelly candles, perfumes, or cleaning materials), use a harness instead of a collar, and restrict exercise if they are coughing incessantly.”  - Tyler Sugerman

Resources Mentioned:

• ASPCA 888-426-4435 or pet poison helpline 855-764-7661

Read The Transcript:

Welcome to Vetsplanation. I'm your veterinary host, Tyler, or you can call me Suggs. This podcast is about educating pet parents about what is going on with their furry little loved ones. As an emergency veterinarian, I understand how hard it is to explain complex diseases in terms that are understandable for pet parents in a few short minutes before the next critical case comes in.

In this podcast, we can dive deeper into understanding of what our pets are going through and break down those complex medical terms into easier to understand chunks of information.

Just a quick disclaimer: this podcast is for informational purposes only. This is not meant to be a diagnosis of your pet. If you have questions about diagnostics or treatment options, please talk to your veterinarian about those things.

Remember, we are all practicing veterinary medicine, and medicine is not an exact science. Your veterinarian may have different treatment options. The information I provide here is to help pet parents, and it's not related to my place of work. I'm here for you guys to provide free information and knowledge.

If you like our podcast, consider sharing this podcast with at least one friend or someone else who has pets and could benefit from this.

Now, let's jump into this week's episode.

Tyler Sugerman: Hi guys, welcome to the podcast. So, today, I'm trying a new thing. I know that most people don't know who I am, so I'm Tyler or Suggs, you can call me either way. And I'm going to show you guys my podcast I'm going to do — this is where I usually do it, is in my little sort of office here and I'm going to do collapsing trachea for you because I feel like just seeing it is a little bit easier than just listening to it.

So, if you are listening to this on the podcast part, I'm still going to explain things as much as possible. But otherwise, you can go on to, I think it's going to be on YouTube if I remember correctly, it's going to upload to. This is my first time doing this, so you'll have to give me a little bit of leniency here. But you can go on and watch this as well.

So, like I said, we're going to talk about collapsing trachea because I feel like this is a really common thing that I see. I just want to explain things to you.

So, collapsing trachea, basically like the most classic presentation of this is you're going to see very small breed dogs. So, usually like Yorkies, Pomeranians, Pugs, Toy Poodles, and Maltese and Chihuahuas are usually the most common ones. You'll see them coming in with what I call a goose honk or a dry hot hacking or dry honking cough. So, it literally sounds very dry, like literally like a goose, it sounds very strange.

It is most common in our small breed dogs that are also obese too. So, if they're a little bit overweight unfortunately, they're more likely to get this as well, and the cough can worsen, like it can become something that becomes a life-threatening thing. So, we want to try to catch this early and kind of try to figure out how we can manage things the best we can.

It's also really exacerbated by warm weather, which is why I wanted to do this now. As we are warming up in our weather, I want to try to make sure we can keep them as safe as possible. And it can also be exacerbated by excitement, stress, or pulling on collars and really strong scented things. So, if you smoke inside or if you have a lot of really strong fragrances, perfumes, plug-ins, things like that, that can make it worse.

And even sometimes floor cleaners can make it worse too. Like when you're mopping and the floor cleaner is really strong, that can also make things worse. So, we want to try to avoid those things as much as possible.

When you bring them to us, a lot of times what happens is you bring them in, and we do our first initial exam. Most of the time they're not doing this dry hacking cough with us.

So, I'm usually asking my clients to explain to me what their pet is doing, just telling me what it sounds like. Does it sound like it's wet? Does anything come up when they're coughing? Because that'll give me a better idea as to what this might be. Especially if this is a really large breed dog, I'm probably not going to be thinking so much about collapse in trachea as I might be thinking about something else.

But when I see a small breed dog and I see this and it's something that they've had over the years, but it's just going to kind of gotten worse — especially, it happens more in the middle-aged and older breeds, and it doesn't mean that it can't happen to smaller younger dogs.

I do have a technician who her Pomeranian, I don't even think he's two yet, that he definitely has symptoms of collapsing trachea. So, we can still have those things in our younger dogs.

But like I said, a lot of this is me just asking you questions. What is this coughing sound like? And then other than that, you'll see us push on their trachea, so trachea is right here. So, we'll push on their trachea and sometimes, that will elicit a cough or make them cough for us so we can hear it but not often. It just happens when it happens.

So, I'm just going to give you a little bit of overview of anatomy first and then explain exactly what a collapsing trachea is. I'm a terrible drawer so I'm very sorry it's this is not my forte, art is not my forte, but I’m going to try to explain this.

So, in your mouth, you have, then you swallow your food, you inhale, and this right here is going to be your trachea, so that is your windpipe. As soon as you take in a breath, it's going to come down this trachea right here.

And then it's going to go into our smaller areas here. So, those are going to be called our primary bronchi or it's just the first bronchi that it's going to be right here on either side. Those are going to go down into smaller and smaller little bronchi. So, those are called secondary bronchi, tertiary bronchi.

Essentially, this is just the way that air is coming in through a trachea down into our lungs, and then it goes down into our lungs here, and it ends at these little things called alveoli. That’s basically just where air and blood is exchanged.

But essentially, like this part all right here is where we have our bronchi, this is our trachea. So, collapsing trachea can happen like most commonly is going to happen here, which goes through the neck and also, the chest, so like the trachea is really long.

And then you can also have some collapsing here in the bronchi, but it essentially does the same thing but they're much harder to diagnose. So, usually, we'll find it most commonly right here in the trachea. So, what happens? So, we have this flattening of what's called the trachea or the tracheal rings.

So, our trachea is this nice round tube. It's supposed to be nice and round. And then about three quarters of it here, is going to have these rings around it, so that way, it's able to maintain a structure. It's cartilage that's in there, so it helps keep it very round.

But then on the top here, the top part of the trachea is muscle. Now, what happens to muscle when we get older, we're not using it and it starts to become saggy. This is the same thing that happens with this muscle of the trachea. So, instead of it being a nice round tube, now, we're actually more like this.

So, the trachea sags down and we now have less room inside of our trachea to be able to breathe. Here we have a normal trachea, see all that room we have, and now it collapses and we have much, much less room for it, all the air to come in and everything that we normally would cough out to come out.

So, that can happen because the rings are starting to weaken and it kind of flattens out like this. That could be because that muscle is just weaken and sort of flattens out more like a heart-shaped is what I think it looks like.

It could be that the lumen or the middle of their trachea becomes this much smaller, so it'll just become much smaller like this. And it can also be from muscle intermittently sagging. So, sometimes, it sags down and sometimes, it goes back up.

Now, the pressure inside the trachea of the neck actually occurs the most, like there's the most pressure when the dog is inhaling, and so when it's in the neck and it's a collapse in trachea, it'll usually be when they're inhaling, and there's more pressure in the chest part of the trachea as the dog is exhaling.

So, that tells us when we're going to have changes in the trachea when we're doing things like X-rays because I can't physically see this when the dog is breathing, you can't see the trachea. So, we usually have to take X-rays to figure out whether they potentially have a collapsing trachea or there's lots of other ways to do it as well.

They can do what's called fluoroscopy, which is super cool. It's essentially, like they're taking X-rays, like an X-ray, after an X-ray, after an X-ray, so you can see everything moving just in time with it being live. I always think that's super cool but that is something that you do with an internal medicine specialist, not something you do with a regular veterinarian or with an emergency veterinarian.

So, when this happens, that's kind of hard because we don't know is this going to happen when the dog is inhaling, and we need to make sure we get an X-ray on when they're inhaling or is it going to happen when they're exhaling. We need to get an X-ray when they’re exhaling.

The other thing is that this changes constantly. So, it's very dynamic, meaning sometimes when the dog is feeling just fine and it's not collapsing, their trachea is very much a circle. And then when they are super excited or they are jumping up and down, they have the leash on them and the collar and it tugs on them, then maybe that trachea then collapses just like this.

It makes it a lot smaller when there's some other big thing that happens. So, we don't always see that on an X-ray and we don't always see that even in fluoroscopy if the dog doesn't have that severe of a collapsing trachea. But sometimes, it's there constantly and that's just what we're going to see.

So, why does this happen? We don't actually know, there's lots of things that can be a factor. This could be that because of the fact that our dogs, a lot of them, they have like a lot of complicating factors to this. They think that maybe this is from obesity.

So, because though we have all this fat that sits on top of our trachea and instead of it just being a really nice round circle, maybe just flattens because we have so much fat on top of there. They think that it could be from — especially in dogs who have brachycephalic syndrome.

Essentially, a brachycephalic means a dog that has a really flat face, so I think pugs, bulldogs, things like that, but more in our pugs because they're smaller. So, they’re really flat-faced and so as they're inhaling, they kind of squish down their trachea. Remember during inhaling, that's when the part of the neck trachea squishes down.

So, it could be from that, it could be if they have some lower airway disease meaning there's something going on inside the lungs. Sometimes, we'll hear crackles and stuff, essentially, we call that bronchitis but it's just inflammation of the bronchi. Remember, we were talking about trachea, bronchi, all the other bronchi.

So, it could be that we have some problems with our bronchi or some lower airway disease, it could be from some upper airway disease. It could be that they have an upper respiratory tract infection, and that makes their trachea collapse even more as well.

They could have things like laryngeal paralysis. Alright, this one's going to be a little bit harder to describe, but when you have the very beginning part of your trachea here, there is this little flap that just sits over it like this.

And when you breathe, that flap opens so that you could take a breath and exhale, and it closes when you go to do things like swallowing, so that way, we don't get food and fluid and stuff down into our trachea, but that little flap sometimes doesn't work. It's not just one flap, it's actually like technically two flaps that kind of sit over it like this.

So, when you inhale, it opens and exhale, it opens. And then when you go to swallow, it closes. But with laryngeal paralysis, you have one side, if it's unilateral or one-sided, then one side opens and closes and the other one doesn't.

And that makes it so that now our trachea that was like this, we had lots of air going in and out, now becomes a much smaller like this, and again, we can't get stuff out, it's harder to breathe in. That happens very commonly in Labradors and stuff, so I’ll go into that some other time.

But it could also be that we have like — they think that there could even be some problems with something called reduced glycosaminoglycans. It just essentially means something that's in our cartilage, and you'll see people giving supplementation for that, and that's totally fine, it's not really going to hurt them. But they think that that leads to softening of cartilage, so they think that some dogs could be having a problem with just not enough of those.

Another thing that can't potentially happen is they can have something called pulmonary hypertension. In one of my other podcasts, I did one on congestive heart failure, and talked a little bit about pulmonary hypertension in there.

But it's essentially, where your heart where it has these pulmonary vessels that are leaving the heart and there can be too much pressure in that vessel and that can also, lead to things like collapsing trachea as well. So, lots of other complicating factors to this.

Now, let's talk about how we're going to diagnose this. Most of the time this is going to be on X-ray. If I get an X-ray, somebody lets me use their X-rays, I will show you an X-ray of what this usually looks like.

But we're going to get an X-ray pretty much from where the chin starts all the way down to the stomach. And that's where we can see our cervical or neck trachea and we can see our thoracic or chest trachea as well.

Remember this is just a snapshot like I said, if it is not collapsing, if it's open during that period of time, we're not going to see that, we're only going to see it when it actually collapses. So, when it actually collapses on an X-ray, that's where we're going to be able to see it and show you what that looks like.

It's still really useful though for trying to rule out other things too, that there's lots of other things that can cause a hacking-honking-type coughing. So, like if we're worried about the dog, having a really large heart, so cardiomegaly is what that's called or enlargement of the heart. That might push up on the trachea and cause a very similar thing.

We could also have pneumonia and maybe we thought that it was dry cough but really, it's a wet cough and we're going to see pneumonia on those X-rays.

Sometimes you can see signs of pulmonary hypertension, it is very hard to diagnose on an X-ray, and even radiologists, that's all they do all day, all day every day is read X-rays. Even some radiologists will tell you we will not tell you if it's pulmonary hypertension. It's just a differential and you have to go get an echo done which is an ultrasound of the heart.

So, now, those can be hard to rule out but that's still something that we're trying to do to try to figure out is this a different problem or is this just collapse in trachea?

Like we said, fluoroscopy is another great one. It's basically looking at the changes of the diameter of that airway in real time, which is really cool. Like you can see it when they're inhaling, and you can see it when they're exhaling. So, you can try to see if this is something that needs to be addressed.

So, fluoroscopy is the other thing, like I said. The hard part about that though is that the patient usually has to be awake when this happens and that's usually not very easy because they are usually asleep when these things occur. It's just hard to do because they move around a lot and if they're not moving around a lot, great, you can get a really good image of it.

The other thing that they can do is a tracheal bronchoscopy. So, tracheal bronchoscopy, that is where you basically get this really good visualization. It's like a camera that they put down in the trachea, so you can see when the dog inhales, like what it's doing, and when it exhales, what it's doing.

You can go from the trachea, you can go down into those bronchi. And again, you can go trachea, you can go down into the main bronchi here and even some little ones depending on how small of a camera that they have essentially. But this one, you usually are anesthetized for it. They're usually intubated so that way, they're able to breathe well still.

And it also assesses for laryngeal dysfunction as well so they can look at those little flaps that I was talking about so they can see if there's any problems with those as well. Really cool techniques, but again, like the fluoroscopy and the tracheal bronchoscopy need to be done with an internal medicine specialist, not with an emergency vet or with a general practitioner.

I talked a little bit about some of the differentials already. So, some of the other things that this could be like I said, heart disease, bronchitis, inflammation of the lower lungs, some sort of obstruction of the trachea.

So, we may have even just a mass or something that could be growing in there that could cause these things. And on an X-ray, it's really hard for us to differentiate between what certain soft tissues, like we can't see the difference between just that muscle and a mass.

Other things are going to be heartworm disease. So, sometimes we'll do heartworm testing to make sure we don't have heartworm disease causing this. Certain types of cancer can cause this as well. If we have cancer inside the lungs, it can make this like coughing sound too.

Kennel cough is another big one. Kennel cough, I've kind of already talked about again in another podcast so you can listen to my other one on kennel cough, but it sounds like a hacking cough. Sometimes, it's not so much like a goose honking, sometimes it's more like a hacking and they'll hack something up with it like white foam.

But most of the time, it's going to be sounding very similar to this and that's not something we can see on an X-ray. We can't do any obvious blood work Initially.

You can send out testing to the lab, and that'll tell you if they do have kennel cough. Kennel cough is a wide variety of different types of viruses and bacteria, it's not just one thing. So, again, sometimes it’s hard to diagnose. So, if it goes away, when we don't have it come back again, then probably not laryngeal paralysis — sorry probably not collapsing trachea, then probably just kennel cough.

And then laryngeal paralysis was our other one where we have that area inside our trachea or before our trachea, where we open when we breathe and then close when we swallow. There is a grading system to our coughing dogs.

So, for our tracheal collapsing, it's technically from one to four and one is not very bad and four is going to be really bad. So, that tells you how if it's not really bad, then it might be something we can just do a lot of stuff at home versus if it's really bad, then we have to hospitalize them and look at other options.

So, typically, if you come in and it's just coughing, your dog is just coughing, it's not a really big deal, they're not having trouble breathing or anything, that's probably going to mean just doing X-rays, maybe blood work, and then sending them home possibly on medication if they need it.

But let's say you're coming in and your dog is really bad, like they're a three or a four on our grading scale, they cannot breathe at this point. So, a lot of times that means they're what's called dyspnea, meaning they're not breathing correctly.

We put them into oxygen and we're typically giving them sedation right away. We need them to calm down so that that way they can open up their airways. Sometimes they're getting steroids as well just depending on whether they have other problems. Like if they have a heart problem, we're less likely to give them steroids if that's the case because we don't want to make their heart worse as well.

And then, we also have to treat anything else that's happening at the same time. So, it’s called treating comorbidities, meaning is there other problems we have to address to. Otherwise, if we can hospitalize them, we'll try to get them through this episode, try to get them to the point where they're breathing okay, at least enough to either be able to go home or be transferred to another facility that has an internal medicine specialist who can do some of the other treatments we’re going to talk about in just a little bit.

Some of the other medical management things, so things that we can either do at home or things that we're going to do in the hospital are giving something that's called an antitussive. It means basically to help stop the coughing.

So, we're trying to decrease the amount of inflammation in their trachea by helping them decrease the pressure and stop the coughing. Possibly, using intermittent steroids. Anytime that they are having an episode, maybe we put them on a steroid, alone dose of steroids to try to help decrease that inflammation again.

Some people will use bronchodilators as well. So, think about our inhalers are a really common one, but it just means it's opening up those airways so that that way we can get more air into there, and not have to worry so much about the fact that we don't have enough oxygen getting into our blood because we can open up those airways.

Sometimes using antibiotics is not going to be like a mainstay thing. We try to be really good about not using antibiotics unless we really need to. But it might be meaning to use antibiotics if we think that there might be a respiratory infection. So, if there's an upper respiratory infection — like I said, there's lots of other things that can occur with this and cause it to be worsened.

So, giving antibiotics for upper respiratory tract infections or pneumonia or a lower respiratory tract infection, those are usually the big things we're trying to treat with antibiotics. We're not treating the collapsing trachea itself with the antibiotics.

We might give them anti-anxiety medications to go home. So, something to help just again, try to calm them down, so that way, they're not working themselves up and making this worse.

Sildenafil is another one. Sildenafil is Viagra (FYI). In case you go to the store, and you are picking it up, you should be aware of that beforehand.

But the cool thing about sildenafil is that they actually had started it to help treat pulmonary hypertension and then eventually, found that it actually has this other side effect to it as well. And of course, that other side effect made more money than treating the pulmonary hypertension.

So, when they're treating that pulmonary hypertension, they're trying to decrease the amount of pressure in that blood vessel in the pulmonary vessels so that way we can get more oxygen through and be able to decrease the amount of pressure in our lungs and in our trachea.

The other thing is going to be that if we cannot get them to the point to where they are breathing okay at home, they're really bad, then we need to talk about doing something called a tracheal stent. So, it's like this tube that they put in — it's like this really big mesh tube and the whole point is it keeps it really round.

So, they'll put it into whatever part of the trachea is actually affected. Let's say maybe this part of the trachea is affected, this is in the neck part, but all this trachea down here is okay. So, if it's in this part, they're just going to put the trachea stent in this part right here.

The problem with tracheal stents, they have found that — they've done lots of studies as to whether this is really helpful or not. We always used to think that this was the last ditch effort, go do this when you can't use anything else.

But they have done some studies showing that some dogs have gotten tracheal stents early on in the disease, did much better because they were able to keep all their airways open, they had less secondary problems from it, so they had less pulmonary hypertension and other things.

So, sometimes, it might be a good idea to go talk with the internal medicine specialist to see when is going to be the appropriate time to do a tracheal stent. Here's the problem with tracheal stents, eventually, so we put it in this tracheal stent, goes from here to here.

Well, right here where we had the end of our tracheal stent, it may create scar tissue right there, and instead of it being a nice open airway, now we're going to have this scar tissue that makes it even smaller.

And then they go in, take out the tracheal stent, put in a larger tracheal stent, but eventually, we're going to run out of trachea, and eventually, it can't put more and more in. But that's not for every case, that's for pretty severe cases when this occurs.

Let's say everything goes well, they've been hospitalized, where are some things that we can do at home after they've returned home? Or even if they didn't have to be hospitalized and they're doing well just on medications. So, here are some things that you can do at home for management.

One is remove any of those inhaled irritants we were talking about. So, candles that are really smelly, plug-ins that are really scented, really scented perfumes. Try to put their dog into a different room if you're going to be using some cleaning material that's really hazardous or just has a lot of fumes to it. We want to try to decrease all those irritants, all those things are going to breathe into their trachea.

Don't use a collar, use a harness. So, you can put a collar on them obviously just so we can have identifications, so we know who they are in case they get lost and stuff. But anytime you're walking them, use the harness. So, you can use the harnesses that go around their shoulders and then attach to the back with the harnesses that go down their chest, and attach around their back, those are fine.

The ones that go on their snout, so like the gentle leaders and stuff, I love those. But with the ones who are having this excessive coughing, I don't think that's always a really good option for them because they need to be able to cough and they need to be able to breathe really well. And if they can't open their mouth enough because you're kind of pulling on it, then I think that we're not really doing what it was meant to be used for.

So, I think a harness is going to be much better for that. And they even have harnesses that are specifically for pulling so that they hopefully don't pull as well.

Restricting exercise, that's always a hard one. So, we want to restrict exercise if they're coughing during that exercise. If they're running around chasing a ball or something and they're constantly coughing, we need to restrict that, and maybe we need to do an exercise that is not as extensive or intensive.

I usually suggest for those patients to walk them instead, just try not to let them pull, help just walk them around. We do want them to lose weight if they're overweight, and I think exercise and diet is going to help with that a lot.

So, if they can't exercise, then not really great. We want them to get some exercise, but we just don't want it to where they're like coughing excessively. Because if they do, again, we're going to increase inflammation and that's going to lead them to eventually not being able to breathe, and you’re bringing them into the hospital and seeing me, which I'm always the overnight guy, I'm the guy that nobody wants to see.

Otherwise, let's talk about our prognosis on this. So, with the grade ones or minimal tracheal collapse, that's actually really good. If they don't have any complicating factors, they don't have heart problems, they don't have pulmonary hypertension, they don't have bronchitis, their prognosis is really good. They're usually going to do just fine with doing some of these at-home management things.

Oh, and I forgot to mention because I talked about this earlier, in the summertime, trying to make sure that they're not overheated, keeping them in an air-conditioned or just a really cool house so that way they don't become overheated.

Try not to take them … like if you're taking them to the dog park and stuff, try to make it very minimal and try to make it so that they are inside and cool as much as possible because the heat is going to make this worse as well.

Alright, sorry, back to prognosis. So, the other problem as this disease progresses, there are other things that are occurring, so other comorbidities, other problems that they have that makes the prognosis much worse.

And so, when they're just having these really mild flare-ups and stuff, I usually tell people you probably don't need to see the internal medicine specialist at that point.

But if we're having other comorbidities, we have other problems, or we have … they really are coughing quite a lot, you should see the internal medicine specialist so that you can decide whether a stent is going to be the best thing for them or is this something that can wait.

And if that's the case, then they already know that they have their history, they already kind of know do we need to see this dog sooner if they're starting to notice that we're getting worse. And they can talk to you about the differences in stents, how it affects them, things like that.

Alright, I think that's all I got for my stuff for today.

I do usually have an animal fact at the end of this and I'm sorry I don't have one today. I was really just focusing on trying to learn how to do this really quickly. So, I promise I'll have one for next week.

But if you have any questions for me, like I said, you're always welcome to email me. You can find me on Facebook, Twitter, Instagram, Tik Tok.

You can go to my website at vetsplanationpodcast.com and you can email me there, directly and I'm happy to do any other topics that you guys ask for. I do usually do this at night, so I'm sorry if you hear a lot of the commotion today. Like I do normally do this like in the nighttime, so I was trying to do this during the day so that you could actually see me really well on the thing, but we'll see how it goes at night one time.

Alright, thanks guys.

Thanks for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, feel free to email me at suggs@vetsplanationpodcast.com.

You can visit our website at vetsplanationpodcast.com, or you can find us on Facebook, Instagram, or TikTok at Vetsplanation.

Thank you all again for listening and we'll see you back here next week.