Collapsing Trachea

Collapsing Trachea
By Emily Hoppmann, DVM
The trachea is commonly known as a windpipe. In dogs and cats, as in people, this is the “tube” that extends from the back of an animal or person’s mouth to the chest, where it divides into two smaller tubes (bronchi) that lead to the lungs. Air travels into and out of the lungs through the trachea. The trachea consists of a long column of rings stacked on top of each other. These rings are made of a firm material called cartilage. For unknown reasons, some of these rings can lose their rigidity prematurely with age or are never as rigid as they should be, which allows them to possibly collapse in some dogs (especially smaller dogs). When the rigid tube becomes more floppy it can flutter with breathing, which triggers fits of coughing. This can happen anywhere along the length of the trachea. The problem of a collapsing trachea most commonly occurs in middle-age to older dogs that are toy or miniature breeds (Lhasa Apso, Yorkshire Terrier, Chihuahua, Pomeranian, Toy Poodle, Shih Tzu, and others); however, a collapsing trachea can occur in younger dogs or in larger dog breeds. Very rarely, a dog may be born with this problem (congenital disorder) and have issues throughout their life, which tend to worsen with age.

The most common sign associated with a collapsing trachea is a nonproductive (dry) cough. The cough is often described as a “goose honk” because of its characteristic sound and the cough typically can be triggered by excitement, anxiety, exercise, eating and/or drinking, becoming overheated, and pulling on the collar (though, keep in mind that pulling hard on a collar or leash can trigger a cough on virtually any dog). Some owners report that picking their dogs up under the chest area can bring on coughing caused by a collapsing trachea. Like any cough in dogs (whether caused by collapsing trachea or anything else), dogs generally give the impression that they are trying to “cough something out”, even when there is nothing to cough out. This is an impression that is produced by the repetitive fits of coughing that end in a terminal retch (as if they are going to vomit); a terminal retch is a final, hacking, gagging sound that is louder than the cough and that ends a fit of coughing. A dog may occasionally produce white or yellow mucous-like foam during this final coughing fit. None of these symptoms is specific to collapsing trachea, however, and dogs with any manner of lung, bronchial, or tracheal problem produce the same appearance of symptoms. The cough occasionally may be severe enough to cause the dog to faint, which is extremely scary to owners, but by itself is usually not fatal. In the earliest stages, some dogs with a collapsing trachea do not cough at all and the problem goes unnoticed at home, but may be noted on physical examination by a veterinarian.

Collapsing trachea is usually diagnosed based on a combination of symptoms (coughing episodes brought on by the events listed above). If your dog has another respiratory problem that may be exacerbating the collapsing trachea, several other tests may be performed including digital radiographs (x-rays) of the chest to evaluate the heart, lungs, and other structures within the chest. If your dog has been diagnosed with collapsing trachea, you can do many things to make him or her more comfortable. Some easy things to do at home are to use a harness instead of a collar; this is helpful because a harness fits around a dog’s chest, avoiding unnecessary pressure on the neck. Additionally, it helps to not walk your dog in hot, humid weather. As with all pets, never leave him or her in a car in hot weather because this leads to overheating, making it much more difficult to breath; eventually leading to a pet having a heat stroke, which can be fatal in any pet (but pets with collapsing tracheas or any brachycephalic dogs -dogs with shorter noses – are more predisposed). Also, with pets who have a collapsing trachea leaving him or her in a car can not only lead to overheating, but also can be stressful (even in cooler weather) which can trigger coughing fits. Even after changing from a collar to a harness, avoid over exercising your dog – walks are better than runs and swimming is a great way to exercise your pet without the worry of having them become overheated. For overweight dogs, the excess weight puts a great deal of stress on the trachea, heart, and lungs (along with every other part of the body) so switching him or her to a weight-reducing diet and monitoring weight loss until an optimal weight is reached can help tremendously. We can always help guide you through a weight-loss and exercise plan! If stressful situations are anticipated (for example, strangers will be coming over for a party or a night when there are going to be fireworks), it may be best to give a sedative medication or additional anti-cough medication to your dog before the big event. Often, barking and fast breathing are triggers for tracheal irritation and long bouts of coughing, so activities that can trigger barking or fast breathing should be limited or eliminated. Another easy trick is to elevate your pet’s food and water bowls. There are commercially available stands that you can purchase that keep the bowls at a higher level or you can simply place a bowl or other structure under the bowls to get them at a height where your pet won’t have to bend his or her neck to eat or drink.

For most dogs diagnosed with collapsing trachea, the first thing is to try are the easy tricks mentioned above (switching to a harness from a collar and elevating the food and water bowls) and starting on a diet and exercise plan to get your pet to an ideal weight. If those changes alone do not help decrease the coughing fits, there are some medications that can be helpful. Every individual is different, so the specific type of medication for your dog will depend on the unique features of his or her case and it may take several different trial periods using different types and combinations of medications to find what works best for your pet. There are several types of appropriate medications that work in different ways, such as sedatives, cough suppressants, bronchodilators and muscle relaxers. Sedatives can help a dog relax, which breaks the cycle of anxiety-induced coughing and therefore lessens coughing-induced tracheal irritation. Some types of cough suppressants can be very helpful to break the vicious circle of coughing induced by tracheal irritation which was induced by coughing. Bronchodilators work by dilating the tiny airways that lead to the lungs (called the bronchi) which make the work of breathing a little bit easier for your pet. We will work together to find the life-style changes and correct combination of medications with the appropriate schedule for your pet! Some dogs may only need to be given the medication at certain times of greatest need, but some dogs may need to receive them more often to prevent flare-ups. Just as in people, a dog may respond better to some medications than others so keep in mind that if one medication does not appear to help, please let me know and so we can talk about trying another type of medication or see if there is a need for further diagnostics find out what will work best for your baby!

One thing to also keep in mind is that if your dog has other respiratory or heart problems, along with his or her collapsing trachea, these may need to be treated as well in order to reduce the signs that you are seeing. The treatment for the other issues will depend on the specific problem. Also, it is possible for a medication to become less effective over time or for the current treatment not work as well if the collapsing trachea worsens over time or your pet develops a concurrent disease. If your pet ever appears to have gotten worse, please be sure to contact us right away.

Things to keep in mind:
• Be sure to give medications exactly as prescribed
• Use a harness or a Gentle Leader-type face collar instead of a regular collar that goes around the neck
• Avoid placing the dog in situations that you suspect may be stressful or anxiety-provoking or that have triggered fits of coughing in the past
• Realize that collapsing trachea is not a curable problem, but also not one to give up hope on. With the right medication combination, weight loss if needed, and common-sense approaches like using a harness instead of a collar, a normal lifestyle is expected for a dog with collapsing trachea. The cough will most likely never go away all together, but it is a disease that can be managed.
• Keep in mind that a collapsing trachea is typically not as seriousness as it sounds! I know the cough in a dog with a collapsing trachea sounds horrible, but a collapsing trachea by itself is not usually a fatal disease.
• Always check to be sure the gums and tongue are pink (and not blue or grey) and the breathing effort is normal (not labored) if your dog has a coughing fit. If the gums are blue or grey and the breathing is labored (using the abdominal muscles as well), there is probably something else going on and you need to have your pet examined immediately.
• The cough from a collapsing trachea always sounds worse than it is. To most dogs, collapsing trachea probably feels like a tingling sensation in the throat, not a serious breathing problem. As owners, it seems much worse to us, but just because the cough is loud or frequent does not mean that your pet is suffering or has a poor quality of life. However, if you feel your dog is in distress from collapsing trachea I am always here to help ease your mind and keep your baby as happy and healthy as possible.
• Do not leave any dog in the car with the windows rolled up, especially in warm, humid weather
• Do not force your dog to continue exercising if coughing begins

Things to let me know about right away:
• Your dog shows symptoms of an adverse drug reaction (weakness, drowsiness, anorexia or decreased appetite, hives, vomiting, diarrhea, constipation or straining to have a bowel movement, seizures, etc.)
• Your dog faints and you cannot wake him/her up immediately
• Your dog produces a greenish or yellowish phlegm when coughing (or a similar-appearing discharge comes from the nostrils). It is often normal for a dog to produce a white-foamy phlegm after a coughing spell, but it should not have any strong odor or color to it
• If a medication no longer appears to be effective. Some dogs become “resistant” to some medications after taking them for a while and that means we need to get together to find out what else we can to do be sure they are responding well