How do we treat brachycephalic dogs ethically?

The problem

Veterinary practices are seeing an increasing number of brachycephalic dogs that have conformation-related disease, including brachycephalic obstructive airway syndrome (BOAS). BOAS occurs due to a number of obstructive and restrictive lesion sites that vary between breeds and between dogs within a breed. The clinical signs associated with BOAS are thus variable but typically include respiratory noise, exercise intolerance, regurgitation, sleeping disorders, heat intolerance, cyanosis and collapse.

Often breeders and owners do not recognise the clinical signs of airway obstruction and vets are seeing dogs that have lifelong morbidity. The veterinary literature on BOAS is constantly expanding and it can be difficult to quickly absorb some of the papers on this topic and adapt the information for practical use.

Treating these dogs can be distressing for veterinary practitioners as it seems a preventable condition which has occurred due to prioritising appearance over health. By treating individual dogs appropriately when required but also doing all we can to decrease the number of affected dogs in the population we can approach this problem ethically.

Part of the solution- the BOAS guidelines

We (a group of veterinary specialists, surgeons and anaesthetists all with an interest in BOAS) have reviewed the veterinary literature and created a set of BOAS guidelines for veterinary practitioners. These guidelines are evidence-based. At present, we have not commented on the differences between specific surgical techniques (due to lack of evidence on long-term outcomes) but rather on how cases are approached.

These guidelines are a living document that will be updated every couple of years as the evidence continues to accumulate.

One aspect addressed in the guidelines is the importance of a thorough clinical assessment including an exercise test – such as the Respiratory Function Grading Scheme.

What is the RFG Scheme?

The Kennel Club/ University of Cambridge launched a health scheme in January 2019 for bulldogs, French bulldogs and pugs.

The health scheme is a functional assessment of breathing, performed without sedation, that can be offered to all dogs from these breeds. It is based on breathing noise and respiratory effort/ dyspnoea before and after a short (3 minute) exercise test and is designed to be carried out in general practice. The only equipment that is required is a stethoscope. The assessment typically takes 15-20 minutes and is a good way to introduce the potential breathing issues that can occur in extreme brachycephalic dogs when the dogs are young, so the owners are more aware of clinical signs.

For dogs that require surgery, the RFG scheme can be used to monitor cases after surgery and thus provide an audit of treated cases.

How do we decrease the number of diseased brachycephalic dogs we are seeing?

The long term solution to BOAS in the extreme brachycephalic breeds is not surgical. Rather we need to improve the health of the breeds. There are a number of ways we can try to reduce the number of diseased brachycephalic dogs that we see in practice. These include:

• Reaching potential owners prior to buying a puppy with a prepurchase consultation where brachycephalic health issues can be explained. “The stop and think before buying a flat faced dog” strapline from the BWG is a good place to start with many owners. http://www.ukbwg.org.uk

• Unlike purchasing from websites, people may have to wait longer for a puppy from health tested dogs, but this should be discussed. Buying a dog is not similar to buying a new pair of shoes and the danger of supporting the illegal puppy trade should be explained to owners inclined to buy off the Internet.
• Talking about health issues with breeders or potential breeders and strongly encouraging health testing of the breeding stock. Many Kennel Club breeders are aware of health problems in the breed and are using a variety of health schemes and tests. First time breeders or inexperienced breeders are often not well informed of the health schemes for different breeds and the resources available to understand better the potential issues with each breed and how to minimise the risk of occurrence. The RFG Scheme has breeding guidelines that recommend that severely BOAS affected dogs are not bred. In any breed, not just brachycephalics, exaggerated conformation should be avoided.
• We should be aware of the use of extreme brachycephalic breeds in advertising and on social media. As part of its #BreedtoBreathe campaign, BVA has produced a template letter that can be sent to companies that have inappropriately used brachycephalic animals in campaigns, and encourage them to consult BVA’s pets in advertising guidelines. Practices should also develop a practice policy on the use of brachycephalic breeds in marketing material and social media, to ensure that communication materials do not portray dogs with brachycephalic conformation as cute, humorous or appealing.

By using a consistent and unified approach to the brachycephalic problem, we are more likely to keep the trust of owners and breeders and keep the conversation progressing around health.

Additional Resources

https://www.vet.cam.ac.uk/boas

https://www.cfsg.org.uk/wp-content/uploads/2020/11/CFSG-Dog-Conformation-Guidance-2020.pdf

http://www.ukbwg.org.uk

https://www.bva.co.uk/take-action/breed-to-breathe-campaign/