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A recent question from a reader:

“My 5-year-old little Yorkie has always coughed some when she gets excited. Last month she started coughing a lot more. Now the vet says she has a collapsed trachea. How do you decide when to euthanize a dog with tracheal collapse? I don’t want her to suffer or be in pain!”

–Elaine C.

Yorkshire Terrier with tongue sticking out

Dear Elaine,

The vast majority of the dogs I’ve cared for with tracheal collapse have mild to moderate symptoms. They do well with symptomatic treatment and lifestyle adjustments. Owners of these dogs rarely have to think about their quality of life. 

If your dog has severe tracheal collapse, I recommend you go through a good Quality of Life questionnaire before deciding to euthanize her. I like the HHHHHMM Quality of Life Scale which gives you a more concrete evaluation than some others. 

Quality of life questions focus on whether the animal can eat and drink, whether their pain can be treated, and how much they can participate in daily activities. 

Answer the questions as objectively as possible. Get a trusted family member or friend to give their opinion, too. Take a day or two to weigh your choices carefully.

When to Say Goodbye

Your dog has a poor quality of life if she is constantly coughing and can’t get enough oxygen to participate in normal activities on most days. If you’ve tried various treatments, consulted your veterinarian and you still can’t improve the situation, euthanasia is a viable option.

I’m happy to report that even dogs with severely collapsed trachea can benefit from symptomatic treatment and lifestyle adjustments. And surgical intervention can be considered for dogs who don’t respond to medical treatment. 

If you haven’t explored these options, discuss them with your veterinarian or ask for a referral to a specialist before you decide to euthanize your pup.

Causes of Collapsing Trachea in Dogs

Collapsed trachea is almost always a disease of small dog breeds, but we don’t know if it is an inherited trait or not. Some of the breeds notorious for having collapsed trachea are Yorkshire Terriers, Chihuahuas, Pomeranians, Toy Poodles, Shih Tzus and Maltese. 

Some scientists think an abnormality in the cells that produce cartilage or a deficiency in the building blocks of cartilage are responsible for collapsed trachea in dogs. 

The disease usually starts in dogs over the age of 2.6 years (9) and gets worse as they get older. Only about 25% of affected dogs show symptoms as puppies before six months of age. (4)

Weak Cartilage and Excessive Tissue

The trachea is simply a tube that leads from the mouth and nose to the lungs. That’s why it’s called the windpipe or airway. It can bend as your dog moves because it’s made of soft tissue propped open with a series of stiff cartilage rings. 

Tracheal collapse happens when the rings aren’t stiff enough to hold the inside of the trachea open. The rings are C-shaped and go about 80% of the way around the trachea, but the top side is not supported by them. This soft portion is called the tracheal membrane and when the cartilage is not stiff enough, it sags into the windpipe. 

The other cause of a collapsed trachea is excessive tracheal membrane tissue sagging into the tracheal lumen. This can happen even if the cartilage is performing normally. Some dogs have both weak cartilage and excessive membrane.

The trachea can collapse (cervical or extrathoracic trachea) in the neck or inside the chest. Breathing in collapses the cervical trachea and breathing out is more likely to collapse the trachea in the chest.

Maltese dog

Symptoms of Tracheal Collapse

Coughing

When cartilage rings bend too much, the inside of the dog’s windpipe rubs together setting off a cough reflex. The sound may be like hacking, a honking cough or a milder throat-clearing sound depending on the severity of the tracheal collapse. 

Excitement and pulling on a leash are some of the most common exacerbators. Barking, allergies, and poor air quality can all add to airway irritation, too.

In advanced tracheal collapse, the inside hollow part, or tracheal lumen, stays nearly closed much of the time. When the dog barks or becomes active, the irritation leads to coughing which puts more pressure on the trachea.

Respiratory Distress and Fainting

Another one of the clinical signs of severe collapsing trachea is respiratory distress. Dogs who are obese and/or have heart disease are more likely to suffer from distress and labored breathing. The inability to take in enough oxygen for normal body function causes a type of pain. 

Some dogs even collapse or “faint” from a lack of oxygen. Sometimes it’s hard to differentiate a fainting episode from a seizure. 

If you think your buddy is getting into a situation where he can’t breathe, stay calm and move to a cool dry area as soon as possible. If you don’t notice improvement within ten minutes, make arrangements to take him to your vet’s clinic or an emergency vet clinic. 

Life-saving treatment for severe respiratory compromise may include oxygen, steroids, cough suppressants and sedatives. Many dogs improve significantly over the course of hours with the right kind of care. 

Other Diseases with Similar Symptoms

There are many diseases that can cause coughing that sounds exactly like tracheal collapse. That’s why vets need to take x-rays and do other tests before making a diagnosis. Some of the common diseases that cause respiratory signs are:

  • Enlarged heart with mainstem bronchus compression. Even if a dog doesn’t have congestive heart failure, the heart can become enlarged and press on the area where the trachea joins the bronchi, causing a cough. This is similar to, but not the same as a collapsing trachea.
  • Congestive heart failure. When the heart can’t pump blood efficiently due to disease, fluid starts to leak into the lungs causing a cough. To complicate matters, about one-third of dogs affected with collapsing trachea also had a heart murmur which is an early sign of heart problems (Cohn) so your coughing dog might have both diseases.
  • Primary respiratory disease. These include bronchitis, aspiration pneumonia, respiratory infection including kennel cough, and even cancer of the lungs or trachea.
  • Tracheal hypoplasia. This is a congenital disease where a puppy is born with a trachea that is too small.

Keep in mind that it’s not unusual for a dog to have more than one disease that affects their breathing.

How Long Can a Dog Really Live With Collapsing Trachea?

The vast majority of dogs with collapsed trachea fall into the mild to moderate category. Many never require any treatment for the disease and live a normal lifespan. Others need to take medications like cough suppressants to improve their quality of life. 

A small percentage of dogs are severely affected by collapsed trachea. These dogs not only cough but have trouble getting enough oxygen to stay healthy. 

Their lives are severely limited by their breathing trouble. Once a dog has developed severe tracheal collapse symptoms, many dog owners choose humane euthanasia after a period of weeks to months. 

Apricot toy poodle with tongue hanging out.

Home Treatment for Dogs With Collapsed Trachea

Weight Control

The number one way to help your dog with tracheal collapse is to help them stay slim.

Obese dogs have more fat inside their bellies and chests. This puts pressure on the windpipe. When the dog breathes, the increased pressure leads to a collapsed trachea, making coughing worse.

When I say slim, I mean you can feel the dog’s ribs and see the waist from the side and from above. Many of my clients are so used to seeing overweight dogs, they panic a little when they see their pet at a normal weight.

It’s OK to be able to feel the ribs and pelvis with a light layer of fat over them!

Clean Air

Just like children with asthma, dogs with respiratory problems benefit from breathing clean air and avoiding temperature extremes. Consider the following:

  1. Use a good air purifier. I’ve had good luck with this air purifier by Coway
  2. Buy an inexpensive hygrometer to monitor indoor humidity. Make sure humidity in your house is between 30% and 50%.
  3. Clean your home regularly to minimize dust.
  4. NO SMOKING indoors!
  5. Avoid taking your pup outdoors when pollen or pollution is high.
  6. Avoid cold dry air.
  7. Use great caution to prevent your pup from getting overheated. Dogs who pant hard are more likely to have trouble with a collapsing trachea.

Use a Good Harness

Exercise is important to prevent your dog from becoming obese and for general health. Avoid using a standard neck collar if your pup has airway trouble.

I recommend you use a harness that doesn’t put pressure over the neck or thoracic inlet (the area where the neck joins the chest). Look for a soft, “vest” style harness. Here’s an example of a good harness you can buy from Amazon.com:

Manage Excitement

Dogs with collapsing tracheas tend to cough more when they bark or breathe hard from excitement. Manage your household routine to prevent your buddy from getting overworked by visitors, etc.

Also, boarding is not a great idea for dogs with respiratory challenges like this. Being around a lot of other dogs increases the risk of catching a respiratory infection. And boarding causes many dogs to bark a LOT, irritating the trachea further.

Please think about recruiting an in-home pet sitter next time you go away and have to leave your buddy behind.

Why Is Collapsed Trachea Worse At Night?

Dogs are like humans in that they can suffer from acid reflux at night (gastroesophageal reflux disease or GERD). Acid rising into the back of the throat can contribute to coughing.

Ask your veterinarian about treatment for GERD which may include antacids, promotility drugs and special food

tips for dogs with collapsing trachea

Don’t Be Afraid to Use Medications to Calm Coughing

Coughing is irritating and creates a snowball effect. The more your dog coughs, the more likely he is to keep coughing due to inflammation and increased tracheal secretions from irritation. It’s better to use medications early before it becomes severe and requires stronger meds. 

Your vet might prescribe corticosteroids for short or long term use. These are very helpful to decrease the secondary airway inflammation that happens with this disease. Inhaled steroids like fluticasone can help dogs who can’t tolerate the effects of oral steroids. 

Cough suppressants are another invaluable medication I often prescribe. In some cases, antibiotics might be needed since dogs with airway abnormalities are more susceptible to infection.

The use of bronchodilating drugs is controversial, but seems to help some dogs. It could be because these dogs also have weakness in the tissue supporting their bronchi. 

Remember, it’s OK to use medication to control a cough. Don’t make your dog tough it out, hoping the condition will go away on his own!

More Home Remedies

Keep your pet quiet and calm for a few days if she has a flare-up until medications can restore respiratory tissue to a more normal state. During this time, you should avoid exercise walks or vigorous play, avoid barking, etc. 

Herbs

There are many herbal remedies from Chinese, Ayurvedic and Western medicine that are made to treat respiratory illness. Many plants have been shown to have antitussive and expectorant qualities for humans (7).

I’ve recommended some of these for dogs under my care in the past with mixed results. They definitely don’t seem to be as effective as prescription medications like steroids and antibiotics.

One combination herbal product you can buy without a prescription is Breathe Well by Safe-Bay. It contains a mixture of herbs traditionally used to treat respiratory issues in humans. There is no clinical evidence to support its use in dogs, but online testimonials indicate the product may help some animals.

Check with your veterinarian before starting any herbal remedy especially if your dog is taking any prescription medications.

Other Remedies

Beyond prescription medication, you might be able to calm your dog’s cough with over-the-counter and natural remedies. These can help with calming, coughing and overall health but they’re not meant to take the place of prescriptions. 

Here are some of the home remedies you may have heard about to help with collapsing trachea. 

RemedyEffect
Dog-Appeasing Pheromone (DAP)Clinical trials support the use of DAP to treat anxiety in dogs (11). Use a diffuser, spray or collar to calm your dog since a calm dog is less likely to cough. 
BenadrylThis antihistamine may help if allergies are contributing to respiratory trouble.
HoneyA 2018 study on coughing children found honey worked better than no treatment to relieve symptoms (12). There are no studies on dogs, but it’s reasonable to think honey could have a positive effect on them, too.
Essential OilsAromatherapy may be beneficial in calming anxiety in humans (10). We don’t have studies on dogs. Be very careful if you try essential oils because they can irritate respiratory tissues and make things worse. Get a veterinarian who is well-versed in using essential oils to help you.
Glucosamine and ChondroitinThe idea is that this supplement could strengthen tracheal ring cartilage. There is no proof of this but glucosamine is generally safe and may help with arthritis.
CBD OilCannabinoids have been found to have a cough suppressing effect on anesthetized cats (8). We need more studies on whether non-psychoactive CBD can help dogs with respiratory signs. Anecdotal reports claim CBD has a calming effect, so it could help prevent coughing by reducing anxiety. 
S-Adenosyl L-Methionine (SAMe)Many dogs with chronic airway obstruction develop liver abnormalities due to lack of oxygen (1). SAMe is a nutritional supplement that may aid healing in the liver (13). I recommend Denamarin which contains SAMe and a few other liver helpers.

Should Your Dog Have Surgery?

Surgical intervention is more of a last resort done for dogs with severe symptoms of tracheal collapse. If medical treatment fails to alleviate severe symptoms, surgery can be considered.

The two types of surgery to open a dog’s sagging windpipe are the placement of external rings and insertion of a supportive tube (stent) inside the trachea. Placement of stents is currently a more common procedure. 

Stent placement requires special skills and equipment including a fluoroscope which is kind of like a live-action x-ray. Placement of supportive stents is done under anesthesia but is minimally invasive. These procedures are usually done by specialists and often at veterinary colleges.

Stents look like a mesh tube made from nickel and titanium or stainless steel. Before surgery, the tubes are compressed very small within another straw-like tube that can easily fit in the airway. 

Once the apparatus is centered in the right spot inside the trachea, the straw-like outer tube is pulled back, allowing the stent to expand to fit the inside of the windpipe. The mesh tube stays in place long-term to keep the airway propped open.

Here’s a cool video from Animal Medical Center in NY showing a tracheal stent being placed with the help of fluoroscopy:

Prognosis for Stents

One study of 18 dogs that had tracheal stents placed found 11.1% mortality (death) within 60 days and half the animals had some sort of post-surgical complication. But overall, they had a “fair to good outcome.” (5) 

A 2019 study of 75 dogs who underwent tracheal stent placement showed a median survival time of 2.75 years. Remember that means some dogs lived longer and some did not live as long as the median time. In that study, younger dogs and male dogs tended to survive longer. (14)

Complications of tracheal surgery include infections, acute respiratory failure, laryngeal paralysis and implant or stent migration. 

It’s also important to note that surgery is not usually a complete cure. Most animals still have some symptoms that need medical management. (3)

My professional opinion? If your dog has advanced tracheal collapse and you’ve tried all the interventions listed above, it’s worth it to try surgery. 

Cost of Tracheal Stent Surgery

The cost of simple tracheal stent placement is around $3000 for otherwise stable dogs. Of course, costs will vary by geographic location.

For pets needing hospitalization for respiratory or other problems, the cost could be significantly more.

If your pet is relatively healthy aside from airway problems, surgery could allow a big improvement in their quality of life. Your veterinarian can help you decide if surgery is a good idea for your buddy.  

Sincerely,

Dr. T.


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Click to View References
  1. Bauer, N. B., Schneider, M. A., Neiger, R., & Moritz, A. (2006). Liver disease in dogs with tracheal collapse. Journal of veterinary internal medicine, 20(4), 845-849.
  2. Cohn LA: Tracheal Collapse: A Common Cause of Cough. Central Veterinary Conference 2013.
  3. De Madron E: Treatment of Tracheal Collapse with Vet-Stents® in 36 Dogs: Complications and Long-Term Results. ACVIM 2009.
  4. Done, S. H., Clayton‐Jones, D. G., & Price, E. K. (1970). Tracheal collapse in the dog: a review of the literature and report of two new cases. Journal of Small Animal Practice, 11(11), 743-750.
  5. Durant, A. M., Sura, P., Rohrbach, B., & Bohling, M. W. (2012). Use of nitinol stents for end-stage tracheal collapse in dogs. Veterinary Surgery, 41(7), 807-817.
  6. Ettinger SJ, Ettinger SJ, Feldman EC : Diseases of the Trachea and Upper Airways. Textbook of Veterinary Internal Medicine, 7th ed. St. Louis, Saunders Elsevier 2010 pp. 1066-88.
  7. Gairola, S., Gupta, V., Bansal, P., Singh, R., & Maithani, M. (2010). Herbal antitussives and expectorants—a review. International Journal of Pharmaceutical Sciences Review and Research, 5(2), 5-9.
  8. Gordon, R., Gordon, R. J., & Sofia, R. D. (1976). Antitussive activity of some naturally occurring cannabinoids ins anesthetized cats. European journal of pharmacology, 35(2), 309-313.
  9. Ing SM, Lascelles BDX, Baines SJ, et al: Surgical Management Options for Tracheal Collapse–A Preliminary Retrospective Study of 14 Cases and Evaluation of Post-Surgical Outcome. British Small Animal Veterinary Congress 2008.
  10. Malcolm, B. J., & Tallian, K. (2017). Essential oil of lavender in anxiety disorders: Ready for prime time?. Mental Health Clinician, 7(4), 147-155.
  11. Mills, D. S., Ramos, D., Estelles, M. G., & Hargrave, C. (2006). A triple blind placebo-controlled investigation into the assessment of the effect of Dog Appeasing Pheromone (DAP) on anxiety related behaviour of problem dogs in the veterinary clinic. Applied animal behaviour science, 98(1-2), 114-126.
  12. Oduwole, O., Udoh, E. E., Oyo‐Ita, A., & Meremikwu, M. M. (2018). Honey for acute cough in children. Cochrane Database of Systematic Reviews, (4).
  13. Skorupski, K. A., Hammond, G. M., Irish, A. M., Kent, M. S., Guerrero, T. A., Rodriguez, C. O., & Griffin, D. W. (2011). Prospective randomized clinical trial assessing the efficacy of Denamarin for prevention of CCNU‐induced hepatopathy in tumor‐bearing dogs. Journal of Veterinary Internal Medicine, 25(4), 838-845.
  14. Weisse, C., Berent, A., Violette, N., McDougall, R., & Lamb, K. (2019). Short-, intermediate-, and long-term results for endoluminal stent placement in dogs with tracheal collapse. Journal of the American Veterinary Medical Association, 254(3), 380-392.
dog is coughing from collapsed trachea

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