I have been a Yorkshire Terrier owner for over ten years. For over six years, I have lived with a dog who has a collapsing trachea problem. This condition, at its mildest, is scary, and at its worst, is debilitating and even deadly.
The trachea is a flexible tube that hooks the upper airway to the lower airway and the lungs. It is mainly made up of cartilage rings that are connected by connective tissue and muscle. One of its most important functions is to transfer oxygen to the lungs and carbon dioxide from the lungs, in other words, breathing. If these cartilage rings and connective tissues start to chronically fold in during inhalation or exhalation, the condition is known as tracheal collapse.
Very simply, the trachea can be thought of as a straw. Pressure is applied to it when you breath in and out. As long as the straw stays strong, airflow is unrestricted. However, once it collapses in an area, it is permanently weakened and it collapses more easily and more often thereafter. This condition normally occurs in older dogs, although it can occur in young dogs. The initial signs are usually a mild cough during exercise, excitement, and stress.
There are two types of trachea collapse: cervical, which occurs in the throat area, and intrathoracic, which occurs inside the chest cavity. Cervical collapse occurs during inhalation and intrathoracic collapse occurs during exhalation. It is also possible for the collapse to occur in both places simultaneously. Both are characterized by a classic honking cough, often called a goose honk cough.
A grading system to document the severity of the collapse was devised by Drs. Tangner and Hobson for use in determining the best way to treat the collapse. There are four stages of collapse that are divided into grades I-IV. A grade I classification is characterized by a 25% or less occlusion of the tracheal lumen. Grade II is 25%-50%, Grade III is 50%-75% and Grade IV is 75%-100%. Dogs with a Grade I or II collapse are usually good candidates for medical management of the condition.
The cause of tracheal collapse is a somewhat of an unknown. There are definitely some congenital implications, particularly when the condition occurs in younger dogs, but injury to the throat can also be a cause. It is worth noting that studies have shown that the tracheal cartilage in dogs with chronic tracheal collapse tends to be deficient in glycosaminoglycans which are building blocks in providing structural rigidity to connective tissues.
Tracheal collapse should always be considered when a dog, especially a toy breed, starts to show signs of a chronic cough. The current method of diagnosis is usually a tracheal xray or an endoscopy or radiographic fluroscopy of the tracheal area while the dog is anesthetized. The dog should also be tested for Valley Fever and Heartworm, both of which are conditions that can cause a chronic cough. Also, congestive heart failure can sometimes be the cause of a cough.
The most common treatment for tracheal collapse is to medically manage the symptoms through weight reduction and maintenance, stress and exercise restriction, and drug therapy. A harness should also be used instead of a collar in order to avoid further pressure on the trachea area. Although none of these are a cure, most dogs can be managed quite effectively.
Common drug therapy used in treating tracheal collapse consists of antitussives, anti-inflammatories, bronchodialators, sedatives, and antibiotics. The most popular antitussives for this condition are hydrocodone or butorphanol tartrate (torbutrol). Anti-inflammatories can be helpful in minimizing airway inflammation caused by the trauma of the chronic coughing. Bronchodialators, usually theophylline based, are used to dilate the pulmonary airways which helps to decrease intrathoracic pressure during exhalation thereby hopefully decreasing the degree of tracheal collapse. Sedatives can be used in extreme cases where antitussives do not control coughing spasms and antibiotics can be used when the possibility of tracheal infection, known as bacterial tracheitis exists. Owners of dogs who suspect or know that their pet has a collapsed trachea should be working closely with a veterinarian that is familiar with the condition in order to diagnose it and determine the best course of action.
If it becomes impossible to maintain the condition medically, there are several surgeries that are available. The only one that has resulted in long-term, repeatable success is the application of an extraluminal prosthesis. The two most commonly used prostheses are the spiral prosthesis and the total ring prosthesis. Both prostheses are fabricated from a 3-ml syringe case or barrel. Which is used, the case or the barrel, depends on the size of the dog. During the surgery, the prosthesis is applied to the outside of the trachea in order to help it hold its normal cylindrical shape. The spiral prosthesis is probably the more useful of the two as it can span a much greater length of the trachea. The ring prosthesis is more like a cuff, spanning about a one centimeter area. The initial spiral prosthesis surgical procedure has been modified to maintain blood supply to the trachea during surgery in order to reduce the likelihood of the tracheal tissue dying due to interruption of blood flow. This surgery has a moderately high success rate, although it would likely be higher if the surgery option was not so often delayed until the patient was a high surgical risk.
There was some research done on a non-surgical procedure where a stainless steel mesh stent was placed on the inside of the trachea to force it to hold its shape, but this turned out to be a failure. An abstract proposal for the study was written, but there was no follow-up paper. A conversation with a veterinarian on the project unfortunately revealed that the proposed idea did not yield successful results.
For over six years I have lived with the collapsing trachea condition in my now ten year old Yorkie, Joy. It started out as a dry, hacking cough that occurred when we went for a walk. She would pull on the leash and then end up coughing. This persisted and I finally took her to the vet. She was tested for both Heartworm and Valley Fever. It took several tries to find a veterinarian who could accurately diagnose her problem. A tracheal xray was done and it showed a slight, but definite intrathoracic collapse. I switched to using a harness instead of a collar and started limiting the amount of exercise that she got. I also had to aggressively manage her weight. The paradox of being unable to exercise her and having to maintain control of her weight was difficult to overcome. This course of action seemed to help for several years, but unfortunately, Joy's condition has slowly worsened. In the last several years I have had to start managing her condition with antitussives and anti-inflammatory drugs on an as needed basis. In February 1995, I had another tracheal xray taken and the results were fairly daunting. Her trachea appears to be collapsed within about 1/4". The collapse has progressed to the point that she coughs during any exercise or excitement. When she barks, she usually coughs two or three times before she can actually get the barking sound out. Bedtime is a particularly stressful time for her and she coughs a lot while trying to get settled in. She also tends to cough when she adamantly wants something, like to go outside or her dinner. I do still consider the tracheal surgery to be an option, although the survival rate does not seem high enough to make this a reasonable option for now. As noted before, this could be due to the fact that this option seems to be used as a last resort to save an animal's life as opposed to a corrective procedure before the condition becomes critical.
Along with the tracheal collapse and the constant coughing and respiratory problems, Joy is also starting to experience a few other problems as well. The right side of her heart is enlarging most probably due to her increased respiratory problems. And it has become a catch-22 in that her heart now seems to be pressing on her trachea to some degree. There is a possibility that she will have to deal with congestive heart failure some day. And as if that was not enough, it is likely that she also has a hernia forming where she had abdominal surgery in the past. I have recently learned that chronic coughing can be the cause of quite a few problems such as this.
In my search for what to do to help my dog, I have run across several ideas worth passing on. As I mentioned, it was very hard to limit Joy's exercise and still maintain her weight. The original solution was limit her intake of food which left her constantly hungry. She weighs about 4.5 pounds and she was getting approximately 1/8 cup of dog food twice per day. I started supplementing her meals with crispy rice cereal or canned vegetables, and finally settled on a homemade weight reducing diet of oatmeal, fresh vegetables, cottage cheese, yogurt, ground meat (chicken, turkey, or beef), and wheat bran. I am able to give her nearly half a cup of food per day and still maintain her weight. I also supplement this with pet vitamins, as well as several other natural health products. I highly recommend the book Dr. Pitcairn's Complete Guide to Natural Health for Dogs and Cats, by Dr. Richard Pitcairn and Susan Hubble Pitcairn for anyone interesting in pursuing a homemade diet.
Another noteworthy thing I did was to start giving Joy Glyco-Flex, made by Vetri-Science Laboratories. This supplement is most often used in arthritic animals or animals who are stiff or in pain due to dysplasic hips or other joints because it helps to increase synovial joint fluid. Glyco-Flex is a natural source of glycosaminoglycans, chelated minerals, vitamins, enzymes, amino acids, and nucleic acids. It made from freeze-dried Perna Canaliculus Mussel, which is an edible shellfish, and is marketed as a whole food supplement for connective tissue support. My justification for doing this was based on an article that I read where it was stated that many tracheal collapse patients had a notable deficiency in glycosaminoglycans that affected the structural soundness of the trachea. I am not aware that Glyco-Flex has been officially tested for use with this condition, but I don't see any harm in giving it a try. I can't tell yet if it has made a difference, but it is relatively inexpensive and I will continue giving it to her. Glyco-Flex is sold exclusively through veterinarians, but you can contact Vetri-Science Laboratories at 800-882-9993 for information on the product and who sells it in your area. Please note that I have no interest in this company other than my opinion that they make good products that can potentially help my dog.
And finally, time and time again, I have been able to stop Joy's coughing spasms by holding her draped over my arm, against my side, with her chest resting on my forearm. I am not sure why this seems to help, but I can guess that it somehow relieves pressure on her trachea and it uncollapses enough to let air flow freely.
It is my hope that research on how to correct and even prevent tracheal collapse will continue to be done. It is a heartbreaking problem to live with. It is one that causes both the owner and the dog to suffer. Joy and I have managed to miraculously overcome many of her other health problems, and we will continue trying to conquer this one.
Coyne, B.E., Fingland, R.B., Kennedy, G.A., DeBowes, R.M.: "Clinical and Pathologic Effects of a Modified Technique for Application of a Spiral Prostheses to the Cervical Trachea of Dogs", Veterinary Surgery, 22,4: 269-275, 1993.
Padrid, P., Amis, R.: "Chronic Tracheobronchial Disease in the Dog", Veterinary Clinics of North America: Small Animal Practice, 22,5:1203-1210, 1992.
Fingland, R.B. :"Tracheal Collapse", Current Veterinary Therapy X, Small Animal Practice. Philadelphia: W. B. Sanders, 1989, pp. 353-360.
Snyder, L: "Tracheal Collapse in Yorkshire Terriers", white paper
Snyder, L., Personal Communication, 1995.
Matthews, K., Personal Communication, 1995.
Copyright 1996 by Mary Kay Keppler. Published in the April/May 1996 issue of The Yorkshire Terrier Magazine. Please do not distribute without my express written permission.
2/97
We lost Joy in September, 1996 under a tragic set of circumstances. My heart is still so broken; she was my heart and my soul, she was everything to me. If you find help here, please send a prayerful thank you to Joy. It is she who brings the help to you, thru me. That her life can still help people and their dogs is a special tribute to all that she was. Thank God for Joy.
mkk