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Collapsing Trachea

Trachea is the scientific name for the structure that many refer to as the windpipe, the main airway that connects the nose, mouth, and throat to the lungs. The trachea is meant to be a fairly rigid structure, consisting of muscle connecting a group of cartilaginous rings. The rings are not complete circles, but rather form a C with the open end of the C facing towards the animal’s back. This muscles covering the open end of the C are called the tracheal membrane.

When the diaphragm (the flat muscle separating the abdomen from the chest cavity) flattens and the intercostal muscles (the muscles between the ribs) move, negative pressure is created and air is sucked into the lungs. When the muscles move the opposite direction,  air is pushed out of the lungs. The trachea serves as a pipeline that brings air into and out of the chest cavity. Part of the trachea is in the throat but it extends into the chest as well so that we can look at the trachea as having an intrathoracic portion and an extrathoracic portion.

Tracheas collapse because the C cartilage flattens due to weaknesses in the tracheal cartilage. When the C rings lose their curvature, the trachea across become loose and floppy. Instead of being a tight muscle covering, the membrane moves as air passes through the trachea. When air rushes into the chest, the membrane of the intrathoracic trachea balloons outward and when air rushes out, the membrane of the intrathoracic trachea droops down into the C cartilage causing an occlusion. The tickling sensation of the membrane touching the tracheal lining generates spasmodic, often severe coughing and if the obstruction interrupts breathing, the patient may develop breathing distress and the sensation of asphixiation. If the collapse is in the extrathoracic (also called the cervical) trachea, the opposite occurs; the collapse occurs during inhalation balloons during exhalation.

Chest and neck x-rays of dog with collaping trachea

The victim is most commonly a toy breed dog, especially common in Miniature Poodles, Yorkshire Terriers, and Pomeranians. The disease usually becomes problematic in middle to senior age but can occur at any age. The cartilage defect that leads to the flattened C rings given breed predilections favors a likely hereditary cause.

Many dogs with collapsed tracheas do not ever show clinical signs of disease until a second problem complicates things. Factors that tend to enable clinical signs of collapsing trachea include:

-Obesity
-Anesthesia involving the placement of an endotracheal tube
-Development of kennel cough or other respiratory infection
-Increased respiratory irritants in the air (cigarette smoke, dust, etc.)
-Heart enlargement (the heart can get so big that it presses on the trachea)
-If a secondary factor such as one of those listed above should occur and make a previously incidental collapsed trachea a problem, often removal of the secondary factor (weight loss program, getting an air filter, etc.) may clear up the symptoms of the collapsed trachea.

Treatment

The following steps are often helpful in long-term management of the tracheal collapse patient:

-If any of the above listed secondary problems are of concern, they must be addressed. This may mean that the owner gives up smoking cigarettes inside the home or that the dog goes on a formal weight loss diet and exercise regimen or other treatment to resolve the exacerbating problem.
-Dogs with collapsing trachea become unable to efficiently clear infectious organisms from their lower respiratory tracts, thus antibiotics may be necessary to clear up infections.

-Cough suppressants such as hydrocodone or torbutrol may be handy.
-Corticosteroids such as prednisone and related hormones cut secretion of mucus effectively but are best used on a short term basis only due to side-effects potential. Long-term use may promote infection and weaken cartilage further.
-Airway dilators such as theophylline or terbutaline are controversial as they may dilate lower airways but not the actual trachea. By dilating lower airways, however, the pressure in the chest during inhalation is not as great and the trachea may not collapse as greatly.
-In a recent retrospective study of 100 dogs with collapsing trachea, 71% responded to medication and management of secondary factors (obesity, irritants in the air, etc.), 7% had disease so severe that they died within one month of diagnosis, 6% had severe additional disease problems, and the other 16% were felt to be candidates for surgical treatment.

Emergency

The patient’s distress can reach a level so severe that the normally pink mucous membranes become bluish and collapse can result. When this occurs, tranquilization is helpful to relieve the anxiety that perpetuates the heavy breathing and coughing. Oxygen therapy and cough suppressants also help. If the patient reaches the point where distress seems extreme or if collapse results, treat this an emergency and rush the pet to emergency veterinary care.

Surgery

If medical management does not produce satisfactory results, it is possible that surgery may be of benefit. A metallic mesh is inserted into the region of tracheal collapse acting as a stent to keep the trachea open and patent.  This surgery is often effective for extrathoracic collapsing trachea, but can be very costly.  Should the intrathoracic trachea be involved, the surgery becomes far less successful, and even more expensive.

In all surgery cases, the younger the patient, the more successful the surgery is likely to be, with success dropping off in patients over age 6 years. Severity of the collapse prior to surgery is not a tremendous factor in obtaining a successful outcome; improvement is reported in 75% to 85% of patients.

 

Roger Welton, DVM

Founder, Chief Editor, Web-DVM.net

CEO, Attending Veterinarian, Premier Veterinary Care

Host, Space Coast Pet Podcast

19 thoughts on “Collapsing Trachea

  1. Bella says:

    I had a 17 year old Maltses, she was three months shy of being 18 years old. My dog never experienced coughing but she started going into bouts of respiratory distress other that she was completely healthy but had cushings. I’m not understanding why surgeon would do a stent replacement on a 17-year-old dog almost 18. I was never told to mortality rate, I was told that she could last a year to two years. I’m not understanding why a vet would risk her life?

  2. Marisella Tresiana Cottafavi says:

    I am in a quandary right now, as I have a 17 years old pug who suffers from an elongated palate and apparently from a tracheal collapse. The vets advised to have an endoscopy performed and a surgery afterwards. And a possible tracheotomy afterwards which will make her stay at the clinic for at least ten days so she can be adequately and properly mbedicated.
    When I asked the vet his opinion on doing surgery to a very senior dog, his answer was, if it was his dog, he will certainly do it but with the knowledge that the dog may not survive. My pug is under sedation for the past 5 days because she’s turned very anxious. She is in and out of cage with oxygen. She cannot breath properly without oxygen.
    I am against making her undergo an operation which will cause unnecessary suffering and which I am not sure if she can survive.
    What are the chances of a 17 years old pug surviving this?

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