CollapsingTrachea

Collapsing Trachea

in Yorkshire Terriers and Toy Breed Dogs

Let me explain my reason for adding this page to my web site...

My little Yorkie Rhett

has been diagnosed with Collapsing Trachea. Fortunately for us we have a wonderful vet who has worked very hard with us to help Rhett in anyway he can.....we are all learning together on the Dreaded Genetic disorder that is occurring more and more in Toy breed dogs as well as larger breeds...I am no way a a trained professional in the causes or the cure, as far as I know there is no cure....there are surgeries that have been done to help correct the Collapsed Trachea, some work,and extend the life of the dog a little longer, but at great expense and heart ache to the owner, some fail, with also the great expense and heart ache. I have chosen to not go the route of the surgery, this is my personal choice, I did not make this choice out of not being able to afford the high cost, when it comes to Rhett, a dollar amount is not important.....but what is important to me is his quality of life....not quantity. So far after a few scares we have him medically managed but...do I want him to be on medication for the rest of his life???? This is a question I have been asking myself over and over.....logically the answer in NO......over time the med's will break down the remaining working parts in his little 5 lb 6 oz body, I can see it starting to happen, I am looking for another way to help him....he is a very happy little boy who loves to run and play with our other Yorkie and his Shih Tzu brother...Rhett loves life......he is only 5 years old, he still has many years he can enjoy life....he is learning he has limitations. Here is a web site I have found that has alot of useful information on it and different treatments for Collapsing Trachea.....Remember if you want to try any new treatment...Please always run it by your vet first.....they are the ones you need to let know what you are doing........I will be trying some of these Herbal Remedies with Rhett.......we need to fix the inside that is broken and not in sync before his medications will work other wise.....

there is also a blog there and you can go in and read about Collapsing Trachea Stories and how these Herbs have helped others.

If you read nothing else please go to this site and read this study.....it just may answer some questions for you

There is also something known as a reverse sneeze....most pet owners think their dog has Collapsing Trachea when their dog does this.....and it very well could be the early signs but this video clearly shows a typical Reverse sneeze episode, this Reverse sneeze is not to be taken lightly but it is not a death sentence.....and it does need to be addressed by your vet. Most dog owners describe it as being more like a sudden and repeated gag. What the dog is actually doing is called a reverse sneeze . It can be normal for some dogs and scary for pet owners that have never seen it. We have a video of what a Reverse Sneeze looks like.

During a reverse sneeze, your dog will make rapid inspirations, stand still with his elbows spread apart, extend his head, and his eyes may bulge. He'll make a loud snorting sound, which might make you think he has something caught in his throat. Many dog owners think their pet is suffocating during a reverse sneeze episode. Each reverse sneezing occurrence generally lasts for less than a minute up to two minutes. Below are a few examples

This is a Yorkie with severe intrathoracic tracheal collapse (grade 4). If my vet graded the collapse this would be Rhett....

This is what reverse sneezing looks like in small breeds. This could also mean other things but in Sparkey's case it is reverse sneezing. you can check with your vet to be sure.

Dog, Reverse Sneeze, this is an Italian Grayhound....this is a typical Reverse Sneeze

The images in the scroller below are Rhett's actual X rays at the time his Collapse was diagnosed, we lost Rhett later this day but were able to revive him, he has been on medication since these were taken. He has also since these were taken lost 2.5 lbs which brought him down to 5.6 lbs. This has helped alot but he is still not out of the woods. We have a wonderful vet who has been right with us the whole time.

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Lateral chest radiograph of a dog with a tracheal collapse. Note the narrowing in the distal cervical region, thoracic inlet, and intrathoracic trachea.

Lateral chest radiograph of a dog suspected of having tracheal collapse. Flat films did not confirm the diagnosis.

Fluoroscopic examination of the dog depicted in previous figure. This inspiratory view shows normal opening of the mainstem bronchi.

Fluoroscopic examination of the dog depicted in previous figure of chest radiograph. This expiratory view shows collapse of the mainstem bronchi with respiration, thus confirming the diagnosis of tracheal collapse.

Tracheal Collapse--Dogs

BASICS

DEFINITION

• Tracheal collapse is a condition characterized by a dynamic reduction in the luminal diameter of the large, conducting airway as a result of weakening of cartilaginous support of the trachea. Redundancy of the dorsal tracheal membrane may further compromise the width of the lumen and compound the clinical signs. Compression of the trachea or bronchi as a result of hilar lymphadenopathy, left atrial enlargement, or external masses is not considered part of the condition described here.

Pathophysiology

• Tracheal cartilages from dogs with tracheal collapse have been shown to be hypocellular.

• Lack of chondroitin sulfate and/or decreased glycoproteins within the cartilage matrix results in a reduction in bound water and loss of turgidity in the cartilage.

• Abnormalities in the cartilage structure may represent degenerative changes secondary to long-standing small airway disease, or they may result from defects of chondrogenesis associated with primary genetic or nutritional abnormalities.

• Abnormal pressure gradients develop along the trachea during respiration, which lead to dynamic collapse of the airway.

• The weakened cartilage allows flattening of the tracheal ring structure, and the trachea collapses, typically in a dorsoventral direction.

• Increased tension on the trachealis dorsalis muscle or neurogenic atrophy of the muscle causes stretching of the dorsal tracheal membrane with protrusion into the airway lumen.

• Chronic pressure fluctuations within the airway lead to perpetuation of small airway disease and more widespread pulmonary dysfunction.

• Mechanical trauma to the tracheal mucosa from collapse of the dorsal tracheal membrane during coughing exacerbates airway edema and inflammation and may lead to pseudomembrane formation.

Systems Affected

• Respiratory--signs from upper airway disorders, such as everted saccules, laryngeal paralysis, and elongated soft palate, may be worsened by severe or protracted dyspnea; lower respiratory tract infection or inflammation are more likely a result of poor tracheal clearance of secretions and bacteria

• Cardiovascular--if the combination of pulmonary diseases is severe enough to lead to pulmonary hypertension

• Nervous--when syncope develops from hypoxia or a vasovagal reflex associated with cough

Genetics Unknown

Incidence Prevalence

Unknown, although the disorder is commonly diagnosed clinically

Geographic Distribution Worldwide

SIGNALMENT

Species Primarily dogs, rarely cats

Breed Predilections

Miniature poodle, Yorkshire terrier, chihuahua, Pomeranian, other small and toy breeds

Mean Age and Range

Middle-aged to elderly with onset of signs from 4-14 years of age. A congenital form also may be observed.

Predominant Sex N/A

SIGNS

General Comments

Clinical signs usually are worsened by excitement, heat, humidity, exercise, or obesity.

Historical Findings

• A dry "honking" cough is classically described for tracheal collapse.

• A chronic history of intermittent coughing or difficulty breathing may be reported.

• Retching is often noted, resulting from an attempt to clear the larynx of pulmonary secretions.

• Tachypnea, exercise intolerance, and/or respiratory distress commonly are reported.

• Cyanosis or syncope may be found in severely affected individuals.

Physical Examination Findings

• Tracheal sounds may be wheezing or musical.

• Enhanced tracheal sensitivity generally is present.

• An end-expiratory snap may be heard when large segments of the airway collapse on forceful expiration.

• Cervical tracheal collapse is present with inspiratory dyspnea, while intrathoracic collapse may be associated with expiratory dyspnea.

• Wheezes or crackles indicate the presence of small airway disease.

• Mitral insufficiency murmurs often are found as a result of the commonality of both cardiac and respiratory disease in small-breed dogs.

• The heart rate generally is normal or decreased for the breed of dog.

• A pronounced second heart sound is suggestive of elevated pulmonary arterial pressures.

• Hepatomegaly has been reported (etiology unknown).

CAUSES

• Congenital/nutritional/familial defects or failures of chondrogenesis

• Chronic small airway disease

RISK FACTORS

• Obesity

• Pulmonary infection

• Upper airway obstruction

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

• Chronic bronchitis

• Congestive heart failure

• Laryngeal paralysis

• Laryngeal mass

• Pneumonia--viral, bacterial, fungal, allergic, or parasitic

• Intratracheal mass or foreign body

• Cervical or mediastinal mass

• Infectious tracheobronchitis

• Bronchiectasis

CBC/BIOCHEMISTRY/URINALYSIS

• Minimum data base to assess general health

• CBC--inflammatory leukogram (secondary to chronic stress of low-grade pneumonia); polycythemia may be found when chronic obstructive pulmonary disease is present

OTHER LABORATORY TESTS

• Arterial blood gases can be used to assess the degree of respiratory dysfunction.

• Calculating the alveolar-arterial oxygen difference (DA-a O2) from blood gas data will differentiate the pulmonary contribution to hypoxemia from that associated with upper airway obstruction.

• DA-a O2 = PAO2 - PaO2 where PAO2 = 0.21 x (PB - PH2O) - PaCO2/0.8 (normal < 15; PB = barometric pressure; PH2O = water vapor pressure [47 at 37o C] and PaCO2 from blood gas data)

IMAGING

Radiography

• Tracheal collapse can be identified by radiography in the majority (60%) of patients.

• Inspiratory films will show cervical tracheal collapse.

• Expiratory films are useful for outlining intrathoracic tracheal collapse. Collapse of the mainstem bronchus and ballooning of the cervical trachea also may be seen.

• Bronchitis, pneumonia, and bronchiectasis may be identified.

• Right-sided heart enlargement may be found secondary to chronic pulmonary disease. Breed conformation may confound interpretation of the cardiac silhouette.

Fluoroscopy

Dynamic collapse of the trachea and/or dorsal tracheal membrane may be more easily identified after induction of cough.

OTHER DIAGNOSTIC PROCEDURES

Bronchoscopy

• The severity of tracheal collapse can be graded (1-4) and small airway disease identified.

• Grade 1--almost normal, slightly pendulous trachealis muscle

• Grade 2--reduction of the tracheal lumen by 50%

• Grade 3--reduction of the tracheal lumen by 75% with the trachealis muscle almost brushing the tracheal cartilage

• Grade 4--tracheal cartilages are flattened, < 10% of the lumen may be visible, a double lumen may be seen when the trachealis muscle contacts the ventral surface of the trachea

• Samples should be submitted for bacterial culture/sensitivity and cytology to guide therapy.

GROSS AND HISTOPATHOLOGIC FINDINGS

• The trachealis muscle is greatly elongated and the cartilages are flattened.

• Tracheal inflammation or pseudomembrane formation may be evident.

• Hypocellularity of the cartilage with decreased glycoproteins and chondroitin sulfate is noted microscopically.

• Variable changes associated with chronic obstructive pulmonary disease may be noted.

TREATMENT

INPATIENT VERSUS OUTPATIENT

• Stable patients can be discharged on appropriate therapy.

• Severly dyspneic patients may require oxygen therapy or heavy sedation.

ACTIVITY

Severely limited pending stabilization

DIET

The majority of affected dogs will improve by achieving weight loss.

CLIENT EDUCATION

• Obesity, overexcitement, and humid conditions can cause a crisis.

• Harnesses should be used in place of collars.

SURGICAL CONSIDERATIONS

Early intervention in selected cases (primarily cervical tracheal collapse) by a skilled surgeon may improve quality of life when adequate stablization of the airway can be achieved and when chronic pulmonary changes do not limit resolution of disease.

MEDICATIONS

DRUGS AND FLUIDS

• Sedation and cough suppression may be achieved with butorphanol (0.05 mg/kg IV, SC q6h).

• The addition of acepromazine (0.025 mg/kg SC) may enhance sedative effects.

• Narcotic cough suppressants such as butorphanol (0.5-1.0 mg/kg PO q6h-q12h) or hydrocodone (0.22 mg/kg PO q6h-q12h) are effective for chronic therapy.

• Some dogs may respond to Choledyl elixir (1 cc/4.5 kg q8h) despite inadequate theophylline levels.

• Theo-dur sustained release tablets (20 mg/kg q12h) or Slo-bid (25 mg/kg) are recommended to dilate the smaller airways and decrease pressure gradients along the trachea.

• Prednisone (0.5-1.0 mg/kg q12h tapered to q48h) may aid in reducing tracheal or bronchial inflammation.

CONTRAINDICATIONS

None

PRECAUTIONS

• Theo-dur tablets should be used, not sprinkles or capsules.

• Generic slow-release theophylline products should not be substituted because of erratic pharmacokinetics.

• Long-term steroid use should be avoided because of the propensity for weight gain or diseases associated with steroid excess.

POSSIBLE INTERACTIONS

• Primarily with theophylline

• Theophylline metabolism is increased by concurrent treatment with ketoconazole and phenobarbital. Inadequate plasma levels result.

• Metabolism is decreased by flouroquinolones (Baytril), erythromycin, cimetidine, beta blockers, steroids, mexiletine, and thiabendazole. Toxic plasma levels results, causing gastrointestinal upset, nervousness, or tachycardia.

• Changes in drug pharmacokinetics associated with congestive heart failure, cor pulmonale, and liver disease necessitate a reduction in dosage.

ALTERNATE DRUGS

Robitussin DM has offered palliation in some patients.

FOLLOW-UP

PATIENT MONITORING

• Weight

• Exercise tolerance

• Arterial blood gases

PREVENTION/AVOIDANCE

• Avoid obesity in breeds commonly afflicted.

• Avoid heat and humidity.

POSSIBLE COMPLICATIONS

Intractable dyspnea leading to respiratory failure.

EXPECTED COURSE AND PROGNOSIS

• Prognosis may be based on bronchoscopic evidence of airway obstruction.

• Various combinations of medical therapy, in conjunction with weight control, should be tried to provide palliation.

• Surgery may benefit some patients, primarily those with cervical tracheal collapse.

MISCELLANEOUS

ASSOCIATED CONDITIONS

• Chronic bronchitis

• Laryngeal paralysis

• Everted laryngeal saccules

• Pulmonary hypertension

• Affected breeds commonly are afflicted with mitral insufficiency, which can complicate the diagnosis.

AGE RELATED FACTORS N/A

ZOONOTIC POTENTIAL N/A

PREGNANCY N/A

SYNONYMS N/A