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November 29, 2009

New Hope for Dogs with Tracheal Collapse


Tracheal collapse is a degenerative disease affecting the cartilage rings of the trachea predominantly in small and toy-breed dogs.

This article will cover the signs seen in dogs with tracheal collapse, tests that can be performed to definitively diagnose tracheal collapse, and the treatment options for the condition.

Clinical signs of tracheal collapse
Coughing is the most common sign reported by owners with dogs that have tracheal collapse. The cough is usually exacerbated by excitement or stress. More advanced cases may progress to respiratory difficulty with dogs showing less energy due to trouble breathing. Most dogs start showing mild signs at young to middle age, which gradually get worse over time. Some cases may become severe to the point of causing cyanosis (turning blue), collapse, and may even be life threatening.

Diagnostic tests for tracheal collapse
Your local veterinarian can perform a number of tests to help diagnose a breathing problem with your dog. Physical examination is helpful to see if manually applied pressure on the trachea induces a cough, as well as evaluate the rest of the respiratory tract and general health status of your pet. X-rays usually reveal a collapsed portion of the trachea. However, sometimes x-rays do not show the full extent or location of the problem.

In those instances, more specialized tests such as fluoroscopy (live “video x-ray” performed while your dog is awake) or tracheoscopy (looking inside the trachea with an endoscopic camera while your dog is under general anesthesia) can be ordered either through your local veterinarian’s office if available, or a specialty referral center with the appropriate equipment.

Medical treatment of tracheal collapse
If your dog is diagnosed with tracheal collapse, the condition can usually be managed with medications and lifestyle adjustments. Equally important is treating any concurrent health problems such as respiratory infections, cardiac, or other airway issues. Common medications for tracheal collapse include various combinations of cough suppressants, sedatives, anti-inflammatories, and/or bronchial dilators. Your local veterinarian can prescribe the appropriate combination of medications to help control your dog’s tracheal collapse. The goal is to minimize clinical signs (cough and respiratory difficulty) without excessively sedating the patient or compromising quality of life. The combination and dosages of medications may need to be modified until the right treatment is found for your dog. As your dog’s condition changes over the course of his or her life, the medications may need to be adjusted. For this reason, regular check-up examinations with your local veterinarian are critical to allow effective management of your dog’s tracheal condition.

Lifestyle changes center around weight loss and avoiding pressure on the neck region. Ensuring your dog is in thin body condition helps make breathing easier and can significantly reduce the severity of signs associated with tracheal collapse. A reduced calorie diet, restricted quantities of food, and limiting or eliminating treats can all help achieve this goal. Finally, switching from a collar to a chest harness will help transfer pressure away from the neck region for your dog.

New hope for surgical treatment of tracheal collapse
In the majority of cases, medical management as described above will successfully help dogs with tracheal collapse. In some cases, the disease progresses to a point where quality of life is being threatened to a degree that cannot be managed with medications and lifestyle changes. In these instances, surgical intervention may be considered.

Various surgical procedures have been described for tracheal collapse with all methods involving placement of supportive materials in, or around, the trachea to prevent collapse. Recently, the development and use of an Intraluminal Tracheal Stent that can be placed into the trachea, have resulted in significant improvements in outcomes for severe tracheal collapse cases that are not being adequately controlled via medical management.

Depending on the case, the stent can be used alone or in combination with special plastic rings surgically placed on the outside of the trachea that are sutured to the trachea to hold it open and prevent collapse.

Placement of tracheal stents and/or rings is an advanced surgical technique that carries notable costs and risks that must be discussed in depth during a consultation with a board certified veterinary surgeon prior to the actual procedure. However, with this recently available advanced technique, many dogs with severe tracheal collapse that would have previously been considered unmanageable can be given a chance to breath comfortably and return to a good quality of life.

Milan Milovancev, DVM, Diplomate, American College Veterinary Surgeons is a board-certified veterinary surgeon currently offering Intra-luminal Tracheal Stenting at the Wisconsin Veterinary Referral Center. Dr Milan provides specialty veterinary surgery and enjoys caring for patients needing soft tissue, orthopedic and/or spinal procedures. For a more complete listing of services available at the Wisconsin Veterinary Referral Center, visit www.wivrc.com.

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