Brachycephalic Airway Syndrome In Cats

What Is Brachycephalic Airway Syndrome in Cats?

Brachycephalic airway syndrome in cats is caused by deformities of the facial bones, nares (nostrils), soft palate, trachea, or larynx. Brachy means “short or shortened,” and cephalic refers to the head; thus, brachycephalic is the term given to short-headed or short-faced cats such as the Persian, Himalayan, and Burmese breeds. Not all brachycephalic breeds will develop brachycephalic airway syndrome, but many will.

Symptoms of Brachycephalic Airway Syndrome in Cats

The symptoms of brachycephalic airway syndrome in cats can vary depending on the severity and number of airway problems. Not every brachycephalic cat will have every symptom, but some possible symptoms include:

• Open-mouth breathing (having to open the mouth to breathe)

• Increased breathing effort

• Noisy or raspy breathing

• Snoring while relaxed or asleep

• Reverse sneezing (forceful inhalations that sound like short burst of snoring)

• Coughing or gagging

• Heat intolerance

• Exercise intolerance, or collapsing during exercise or play

Causes of Brachycephalic Airway Syndrome in Cats

Brachycephalic airway syndrome refers to a specific set of upper airway abnormalities and their resulting symptoms. Possible upper airway abnormalities include:

• Stenotic nares–Many brachycephalic breeds have small, narrow nares, or nostrils. This narrowing results in restriction of airflow entering the nostrils. This can be dangerous when the cat has an upper respiratory infection, as mucus discharge in the nostrils further blocks air flow.

• Elongated soft palate–The soft part of the roof of the mouth is called the soft palate, and in brachycephalic breeds, it tends to be longer than normal. This elongation results in partial blockage of the trachea (windpipe) and can cause less airflow into the lungs.

• Hypoplastic trachea–Some brachycephalic cat breeds can also have a windpipe that is narrower than normal. This narrowing can result in less airflow into the lungs.

• Everted laryngeal saccules–All cats have small saccules (pouches of tissue) just inside the larynx (voice box). However, in brachycephalic airway syndrome, the saccules evert, or get displaced outward, because of the extra breathing effort caused by the stenotic nares and the elongated soft palate. This eversion of the saccules causes further blockage of airflow.

How Veterinarians Diagnose Brachycephalic Airway Syndrome in Cats

A probable diagnosis of brachycephalic airway syndrome in cats can be made through physical examination alone; a cat’s breed, facial structure, and external physical features can help in the diagnosis. However, to find out the severity of brachycephalic airway syndrome, more testing may be needed.

Anesthesia is needed to allow a thorough laryngeal and soft palate exam, as these structures are next to impossible to see well in an awake cat. Your veterinarian will likely recommend pre-anesthetic testing that may include blood tests to check the function of internal organs, chest X-rays to check the heart and lungs, or an EKG to screen for heart abnormalities.

Treatment of Brachycephalic Airway Syndrome in Cats

Treatment of brachycephalic airway syndrome varies depending on severity and quantity of deformed body parts. Regardless of severity, early diagnosis and treatment is ideal, as symptoms tend to worsen the longer brachycephalic airway syndrome goes untreated.

In mild cases, a conservative management may be considered by addressing contributing factors such as weight management, avoiding hot or humid conditions, limiting play or exercise, and treating respiratory infections early and aggressively. In some cases, antihistamines may be recommended to help keep airway secretions (mucus) to a minimum. Other medications, such as Onsior®, may be recommended to treat symptom flare-ups.

Surgery for Brachycephalic Airway Syndrome in Cats

In more advanced cases, surgery to fix the stenotic nostrils and/or elongated soft palate may be all that is needed to improve airflow and quality of life, especially if treatment is started early on. Some general practitioners are comfortable doing such surgeries, while others may refer their patients to a surgical specialist.

Surgical correction of stenotic nostrils is called a rhinoplasty, and it involves removing a part of the nasal tissue to make the opening of the nares bigger to improve airflow. Similarly, surgical correction of an elongated soft palate involves surgically removing a part of the soft palate to improve airflow and stop the risk of tracheal blockage. This surgery is called a staphylectomy.

In severe cases, or in cases where treatment has been delayed, surgical removal of the laryngeal saccules may be recommended to further improve airflow.

Recovery and Management of Brachycephalic Airway Syndrome

Recovery from surgery can vary depending on the procedure. For stenotic nares correction, recovery is relatively easy. Pain management and preventing rubbing of the nose by using an Elizabethan collar or recovery cone, are typically recommended for about a week after surgery.

If surgery involves soft palate removal or laryngeal saccule removal, an overnight stay at a 24-hour care facility may be recommended. Post-op swelling and severe pain can occasionally be a problem after these procedures, and having your cat closely watched is important for safety and proper pain management. Additionally, a soft diet will likely be recommended for the week following surgery.

The prognosis for cats with brachycephalic airway syndrome depends on the severity of their symptoms, how many anatomical abnormalities are present, the age at diagnosis, the age at treatment, and the presence of other diseases.

Prevention of Brachycephalic Airway Syndrome in Cats

Since brachycephalic airway syndrome in cats is congenital (present from birth), and is a result of improperly formed body parts, it can only be prevented by following good breeding practices. Any cat with a history of brachycephalic airway syndrome should not be bred. Likewise, cats with less severe brachycephalic conformation should be favored in any breeding program.