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Breathing Problems

Shih Tzu Breathing Problems

Overview- Perhaps nothing is more worrisome than when a Shih Tzu has difficulty breathing. It may be a matter of acute attacks, an ongoing issue or it may worsen depending on such things as the weather or activity that the puppy or dog is doing. 

Brachycephalic breeds such as the Shih Tzu are prone to breathing issues. A lot of this has to do with the structure of the head. With flat-faced breeds, internal passages are compacted. Though this is not uncommon with the breed, moderate to severe breathing issues are not something that should be assumed to be normal.  

There are many instances where an owner can help improve struggles with breathing, take some steps to help eliminate issues such as breathing heavy and in some cases, veterinary intervention may be needed.

We will go over conditions and situations that can cause Shih Tzu breathing problems as a puppy, those that may develop as he matures or troubles that may start to appear with seniors. 

This section will discuss:
  • Brachycephalic Airway Syndrome and what this means
  • The 3 top concerns of elongated soft palate, stenotic nares and collapsed trachea
  • Breathing spasms due to reverse sneezing
  • Tips to help your Shih Tzu breath better
Brachycephalic Airway Syndrome

This is the term given to brachycephalic breeds such as the Shih Tzu that have breathing issues related to their body structure. It is a general term that includes at least one of the 4 health issues of stenotic nares, elongated soft palate, collapsed larynx (voice box) and trachea issues (abnormally small or collapsed trachea). The 3 most common issues seen with the Shih Tzu are elongated palate, stenotic nares and tracheal issues. With 50% of Shih Tzu that do have airway syndrome, both elongated palate and stenotic nares are present. 

The most common symptoms seen with Brachycephalic Airway Syndrome include:
  • Breathing fast – This may worsen when the dog is excited and/or in hot weather
  • Panting – The Shih Tzu may have episodes of breathing fast and heavy
  • Trouble eating – The dog may gag or even regurgitate food
  • Snoring – The degree of snoring may vary depending on the humidity level in the house and the position in which the Shih Tzu is sleeping. 
  • Noisy breathing – There may be gasping, rattling or wheezing noises
  • Coughing – During an attack, the dog may inhale in such a way that sounds like coughing or the Shih Tzu may have an actual cough; sometimes sounding like honking noises. 
  • Exercise intolerance – Not only may breathing become difficult when the dog is active, it may force him to stop, as he gasps for breath. 
  • Collapse – In very severe cases, the dog may collapse.
Now, we will look at the 3 most common conditions that fall under the category of Brachycephalic Airway Syndrome and then touch on breathing spasms due to reverse sneezing and steps you can take to help your Shih Tzu breathe better.
Shih Tzu wearing sunglasses
Rasta, at 5 years old
Photo courtesy of Lorna Williams
Elongated Soft Palate

The soft palate is the flap of skin at the back of the throat. If the palate is too long it can partially block the entrance to the trachea, or windpipe. This increases airway resistance which can lead to breathing problems. Just about 100% of Shih Tzu have elongated soft palate, again due to the facial structure of the breed. It can range from very slight which causes no symptoms at all, moderate which will cause some problems to be noticed and severe which interferes with the dog’s quality of life. Shih Tzu with breathing problems as puppies should be examined for this issue, because with moderate or severe elongated palates, signs are noticeable when the Shih Tzu is young and it is most commonly diagnosed by the age of 3 years old. 

The Symptoms

• Newborn puppies may dribble milk from the nose when feeding
• Excessive panting
• Unable to calm down quickly when excited
• Choking on food
• Spitting up whole pieces of food
• Loud, raspy breathing when overheated 
• Snoring
• Excessive saliva
• Fainting from lack of air (in extreme cases)

How This is Diagnosed - In minor cases, when it is deemed safe, the vet will examine the mouth when a dog is awake.
However, if a judgment call is made that the examination will cause a dog to become overly excited and this in turn will cause dangerous breathing problems, the dog will be sedated. 

The veterinary surgeon may perform:

• Pre-anesthetic complete blood count and biochemistry
• Blood gases – to check blood pH and CO2 concentration
• X-rays – The vet will also be looking for a narrowed trachea and any heart abnormalities

TreatmentIn minor cases, some changes can be made to help a Shih Tzu breathe better. This includes limiting the dog’s activity during hot weather, trying to avoid over-excitement and encouraging different sleeping positions via canines beds and pillows. However, in most cases in which the obstruction is causing breathing distress that interferes with the dog’s quality of life, surgery is recommended. And it is important to note that this issue often worsens as a dog grows older; in time ligaments in the lynx may stretch, and often to the point of collapse. 

Surgery involves shortening the palate. Many vets prefer to do this after a Shih Tzu has reached the age of 1-year-old. This is because the palate may still grow when a pup is still maturing, and if done too early, another procedure may be required at a later date. Sometimes a dog may need to have his tonsils removed also, and the vet should do this during the palate clip if required. Laser surgery is now the most common way to shorten the palate. It cauterizes as it cuts, which decreases bleeding and swelling, and shortens recovery time.

During post-op recovery, only soft food should be given to allow the throat time to heal. This can include rice with minced pieces of chicken, eggs, oatmeal and sweet potato. Dog food can also be softened with warm water, warmed gravy or warmed low-salt chicken broth. Healing time varies, but the typical healing time is between 2-3 weeks.
Stenotic Nares 

This is the medical term for pinched nostrils. This is caused by inherited malformation of the cartilage in the nose. Essentially, the nostrils are too small (too narrow). These narrowed breathing passages will cause a dog to have trouble taking in air. About 50% of Shih Tzu have stenotic nares to some degree and with those that do, 50% also have the previously mentioned elongated palate. 

Although stenotic nares are present at birth, the symptoms of respiratory difficulty may not begin until a dog is several years old. Surgery is the treatment in moderate to severe cases.

The Symptoms

• Noisy, funny breathing (especially when the Shih Tzu breathes in)
Exercise intolerance 
• Cyanosis (blue appearance of the gums, due to lack of oxygen)
• Fainting (in severe cases)

How this is Diagnosed - Stenotic nares are relatively simple for the veterinarian to diagnose by simply looking at the size of the opening into the nostril. 
Shih Tzu looking up
Dexter, at 3 years old
Photo courtesy of Ralph Goss
However, there may be other issues that go along with this such as a soft palate or a collapsed larynx or trachea that are less obvious and typically require light, general anesthesia for diagnosis. Diagnostic tests are also necessary to determine the general health of a dog. In addition to obtaining a medical history and performing a general physical examination, other diagnostic tests may be necessary, including:

• Listening to the dog’s chest with a stethoscope, in order to help rule out other causes of respiratory difficulty.
• X-rays to check that the heart and lungs appear normal.

Treatment - Treatment is divided into medical management and surgery.

Medical Management - If your Shih Tzu has only mild signs & does not have any other breathing related conditions, this may be able to be managed with non-surgical treatment. This includes:

• Weight loss - As with many health issues, losing excess weight and maintaining a healthy weight can help a great deal. While the Shih Tzu breed is not typically one to be overweight, it is more common with senior Shih Tzu and even just a loss of 1 lb. can help. 
• Avoid stressful situations - Dogs that become stressed or over-excited will have more trouble breathing. Also, you’ll want to avoid the stress of exercising during hot, humid weather. 
• The use of a harness – Though we always recommend this for all Shih Tzu to prevent issues, using a harness any time the Shih Tzu is on leash is part of the treatment program. 

Note: Mild cases can turn severe, so carefully watching your Shih Tzu is very important.
shih tzu in dishwasher
Niko., at 7 months old
Photo courtesy of The Mulcahey Family
Surgery - The surgical procedure for this condition involves widening of the opening through the nostrils, by removing a small piece of the wall of each nostril. This can be done with a scalpel or a surgical laser.

Argument for Delaying Surgery - It is important to note that a Shih Tzu may have more pronounced pinched nostrils (stenotic nares) during the teething phase. As the puppy matures, the nose may open, allowing the breathing problems to decrease or completely resolve. Veterinarians who are not breed specific will often want to surgically fix this as soon as it is diagnosed. However, this may resolve on its own as the Shih Tzu matures. Therefore, with minor cases, you may want to talk to your vet about waiting until the teething stage is complete. 

• Argument for Having Surgery Performed ASAP - A dog with stenotic nares needs to use extra pressure to forcefully inhale. This can cause a dog’s larynx to become weak. With moderate to severe cases, eventually, the larynx may collapse, causing the dog to be unable to move a sufficient amount of air into the lungs. Affected dogs often appear blue (cyanotic) and this can be fatal.
Note: If a Shih Tzu has both elongated palate and stenotic nares, both severe enough to cause difficulty breathing, surgery is almost always the answer. 

Collapsed Trachea

The windpipe is surrounded by rings of cartilage. If these collapse inward (due to either an inherited ‘weak’ trachea or due to injury, such as pressure from being on leash and collar), it is referred to as collapse trachea (or Tracheal Collapse). Though young Shih Tzu puppies may show signs of this, it typically develops in dogs around the age of 6 years old. 

The Symptoms

• Coughing – The majority of dogs with this will have a distinctive cough that is often referred to as a honking noise.
• Noisy breathing
• Gagging
• Trouble breathing, often more apparent right after the dog has exercised or when a dog is excited.
• In severe cases, the gums of a dog may turn blue (due to a loss of air) and the dog may faint.
How This is Diagnosed - Experienced vets will know right away by the particular cough that is present. X-rays are then taken to confirm. In some cases, x-rays will not show a tracheal collapse, however a dog may still be treated for it. If you do desire proof and x-rays are inconclusive, some universities and referral centers perform a test called Fluoroscopy. Fluoroscopy allows visualization of the trachea as the dog inhales and exhales; it is essentially an imaging machine that offers real-time ‘moving images’ of a dog’s internal body structures. 

Treatment- Studies, though ongoing, have shown that approximately 70% of dogs respond well to non-surgical treatment. Treatment will involve a combination of many elements: 

• Eliminating a collar - Immediately, a collar should never be worn and a harness will be used whenever the dog is on leash (this is recommended to prevent this issue). 

• Avoidance of cold - Breathing in very cold air can cause a breathing spasm, therefore you may be instructed to limit your Shih Tzu’s exposure to the outdoors in the winter.
adult shih tzu
Misty Dea, Photo courtesy of Frisca Lisa Laygo
• Avoidance of exercise during hot weather- With this breed, moderate to heavy activity in hot (and especially hot and humid) weather can make breathing difficult so with those that suffer from collapsed trachea, exercise should be restricted during the hottest part of the day. You may still be able to walk your Shih Tzu early in the morning and then later again in the evening as things cool down.   

• Weight loss - Though this is not a problem that is typical with this breed, if your Shih Tzu is overweight, weight loss is recommended as it will put less stress on the body. 

• Non-Steroid Medication - Most veterinarians will prescribe a non-steroidal anti-inflammatories/pain medications. These are NSAIDs and the most common ones prescribed for dogs are Deramaxx, Etogesic, Previcox, Metacam, Zubrin or Rimadyl. 

• Cough suppressants- Common cough medications include hydrocodone, butorphanol, or tramadol.

• Corticosteroids - The most commonly one prescribed is prednisone and this is used on a short-term basis only due to the potential for side-effects with long-term use. This is often given via an inhaler. 

• Antibiotics - Dogs with collapsed trachea are prone to develop lower respiratory tract infections. Therefore, antibiotics will be prescribed as needed. 

Surgery - If non-surgical treatment does not produce any relief and if a dog is having moderate to severe breathing difficulties and/or is in a lot of pain, surgery is often recommended. Most will involve placing prosthetic polypropylene rings to the outside of the trachea. The success rate of this surgery is 75%. It should be noted that it is most often successful with dogs under the age of 6 years old. Since this most commonly develops by this age, there is a small window to both diagnose this and have the highest surgical success rate; you’ll want to bring your Shih Tzu to the vet ASAP if this condition is suspected. 
Breathing Spasms- Reverse Sneezing

Though the above conditions should be ruled out, fortunately, one of the most common causes of random breathing spasms is something that does not cause any ill effects to the dog: reverse sneezing. This is common with both brachycephalic breeds and with toy breed dogs, and therefore very typical for the Shih Tzu. When a dog has a ‘normal’ sneeze, air rushes out of the nose; and with this, air rushes in. Since many Shih Tzu already have stenotic nares to some degree, this can make these spasms even more pronounced. 
The SymptomsThere will be sudden and random attacks of loud and repetitive fast breathing. While it can be mistaken for the honking noise of collapsed trachea, with reverse sneezing there will be consecutive snorting sounds. It can also be mistaken for an asthma attack, with it described as ‘funny’ with quick inhalations. With this, however, the dog will take a stance of extending his neck and spreading his elbows apart. In some ways, it may appear as if the dog is choking on something or trying to cough up a hair ball. The episode will generally be very short, lasting only seconds to perhaps 2 minutes at the most. As soon as it is done, the dog will breathe just fine and behave as if nothing is wrong. 

While it may happen out of the blue, there are some things that can trigger reverse sneezing such as breathing in very cold air, having a rush of excitement, during moderate exercise, wearing a collar that is too tight and/or breathing in an irritant such as air freshener spray or perfume. 

Treatment It is very important to rule out the issues involved with Brachycephalic Airway Syndrome that reverse sneezing can mimic. If your Shih Tzu does have these sorts of breathing spasms, it can be very helpful to take a video of this to show to the vet. If it is indeed reverse sneezing, though not harmful to the dog, there are some things you can do to limit these attacks:
two Shih tzu
Minnie Pearl (at 4 years old) and Mia Karma (at 2 years old)
Photo courtesy of Tomi Clements
  • Gently cup your hand over your Shih Tzu’s mouth and nose area (allowing room for breathing!). This often can help because during an episode too much carbon dioxide is released from the dog’s body. With your hand gently cupped in front of the mouth and nose, it allows a dog to inhale carbon dioxide, restoring it to a balanced level.
  • Place a very small dab of peanut butter onto the dog’s nose. It will prompt the dog to stick his tongue out, which can relax the throat and help to restore breathing back to normal. 
  • Gently massaging the throat area with soft downward strokes can sometimes help, as it also works to relax the area. 
  • Encourage your Shih Tzu to drink or offer a small snack.
Allergies - Allergies can cause a dog to have some wheezing and other slight breathing issues, however there is almost always other symptoms such as itchy skin, rashes and/or water eyes. With others there may also be coat issues and/or runny nose. Since that is a huge subject in itself, if you suspect this, do check out Shih Tzu Allergies.

Breathe Better Tips for All Shih Tzu Dogs

Even if all serious conditions have been ruled out, a Shih Tzu may still have some minor breathing problems. And this, of course, can be frustrating and worrisome for owners who are being told that everything is normal, but they still see their puppy or dog having breathing difficulties.  

There are some steps that you can take to help a Shih Tzu breath better:
serious looking shih tzu
Sassy, at 4 years old
Photo courtesy of Judy Parker
1) Taking action to avoid overheating is key. Follow all summer care guidelines for the Shih Tzu. Limit exercise during very hot weather. Since daily exercise is very important for good, overall health, in the summer take walks early in the morning and then again about 1 hour before the sun sets, as these are the coolest parts of the day. Be sure to bring along water any time you are out and about with your dog and take frequent breaks in the shade. 

2) Keep moisture in the air. For some Shih Tzu, breathing in very dry air can make breathing more difficult. The use of humidifiers can help with this. If you cannot set them up over the entire house, one placed near the dog’s sleeping area can be helpful for nighttime breathing problems.

3) The position in which your Shih Tzu rests and sleeps can cause issues, and this is particularly evident with snoring. The dog should have a quality, supportive bed in which his body does not sink into the mattress. In addition, placing a small pillow under his head to elongate the neck can help him breathe better at night. 

4) If your Shih Tzu seems to have problems when excited, try to intervene before it reaches a point of affecting his breathing. 
This can include taking short breaks from play, making interval introductions to a new place or when meeting new people and distraction if a Shih Tzu is responding to a trigger. 

5) A collar can cause breathing problems in two ways. If too small, it can constrict the neck and breathing passages; collars should be loose enough for you to easily slip two fingers under it. If a leash is connected to the collar, this puts stress on the neck, which not only can interfere with breathing, but can also lead to tracheal injury, particularly with a Shih Tzu that is already prone to this congenital condition. Always use a harness instead.  
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