Tracheal Collapse in Dogs

Tracheal collapse is a chronic progressive respiratory disease most commonly seen in mature toy and small breed dogs. Dynamic airway obstruction is caused by chondromalacia, or weakening of the tracheal cartilages and weakening of the trachealis muscle. Clinical signs may include a “goose honk” cough, raspy breathing, and occasional episodes of dyspnea and cyanosis. Although the condition is not curable, most dogs respond favorably to medical management and can be managed medically with a long term goal of controlling clinical signs and maintaining a good quality of life. Rarely, an interventional procedure such as intraluminal tracheal stenting or a surgical procedure such as placement of extraluminal tracheal rings is indicated to assist in controlling clinical signs.

Medical Management of Tracheal Collapse

Since obesity can exacerbate respiratory problems, maintenance of a healthy body weight is important. Preventing strain on the trachea by using a harness instead of a collar can be helpful as well. Respiratory irritants should be avoided including sprays, perfumes, candles and smoke. Dogs with tracheal collapse should live in a non-smoking home.

Medical management most commonly consists of some combination of four categories of treatment; antitussives (cough suppressants), anti-inflammatories, antibiotics and sedatives (or anxiolytics).

Is my pet a candidate for intraluminal tracheal stenting?

Tracheal stents are often not helpful for a dog that coughs intermittently. They are certainly not a replacement for medical management. In fact, dogs that have a tracheal stent placed are still likely to need medication for life, and they also should be evaluated regularly for complications associated with the stent.

Your dog should have a primary veterinarian that has been involved in treating your pet aggressively. If your dog has failed medical management or is unable to have a good quality of life without steroids, a tracheal stent can be considered. Speak with your dog’s veterinarian about whether a stent might be helpful for your pet. We are happy to speak with your veterinarian if they are unsure about whether stenting is appropriate for your pet.

Tracheal stents can be very helpful for dogs that have obstructive tracheal collapse; meaning they turn blue and/or suffer physical collapse. If your dog is on appropriate medication for tracheal collapse and has had to go to the emergency room or you have considered a visit to the emergency room, a procedure may be helpful for your pet. Some dogs with tracheal collapse can have a tracheal malformation. This is a severe abnormality in the trachea and often occurs at the thoracic inlet. Some of these individuals may benefit from a surgical procedure in which extraluminal tracheal rings are placed.

Checklist for Referral for Tracheal Stenting

Smoking is not allowed in my home.
My dog is currently on hydrocodone and prednisone.
My dog’s primary veterinarian has recommended tracheal stenting.
Recent thoracic radiographs (chest x-rays) have been performed on my dog.
If heart disease is suspected; my dog has been evaluated by a veterinary cardiologist.
My dog’s primary veterinarian has called MISCA and has spoken with Dr. Kuchenmeister or Dr. Reeder about my pet.

Intraluminal Tracheal Stenting

A tracheal stent can be placed minimally invasively with with fluoroscopic and/or endoscopic guidance. The airway is evaluated to confirm the diagnosis, look for complicating factors and measure the airway for proper stent sizing. Benefits of stenting include the minimally invasive approach, the safety of the procedure, and the ability to support the entire length of the trachea. The most common complications of intraluminal stenting are stent fracture or fraying, infection, exuberant tissue ingrowth or tracheal collapse on either side of the stent. Intraluminal stenting is very effective at reducing the severe clinical signs of obstructive tracheal collapse but is less effective at controlling coughing. Careful case selection is important to the success of tracheal stenting.

Click on a fluoroscopic image to view it in full size

Extraluminal Placement of Tracheal Rings

This surgical procedure has been performed less often since development of the tracheal stent as safe placement is limited to the cervical trachea. It also carries the risk of nerve damage (laryngeal paralysis) and tracheal necrosis, as it is a more invasive surgical approach for placement of the rings. However, this procedure may prove superior in cases of tracheal malformation as it can avoid some of the complications associated with intraluminal placement in a malformed trachea. Tracheal stenting can be performed in conjunction with tracheal ring placement to prevent collapse caudal to the rings.

Before the Procedure

Your dog must be referred by your primary veterinarian. Your dog will have a consultation with our surgeon and/or our internal medicine specialist. They perform the procedures together. Fluoroscopy and/or tracheoscopy will be performed to assess the severity and location of the tracheal collapse, and measurements of the trachea must be performed under anesthesia to ensure proper sizing. A second procedure is required to place the stent.