There are several common upper airway diseases seen in canine patients. Each disease has different characteristics and requires a different approach to treatment. In a session at the 2025 Fetch dvm360® Conference in Charlotte, North Carolina, Christopher G. Byers, DVM, DACVECC, DACVIM (SAIM), CVJ, a practitioner in Omaha, Nebraska, and founder and editor of CriticalCareDVM.com, shared tips on diagnosis and management of common upper respiratory tract disorders in canine patients.

Brachycephalic Obstructive Airway Syndrome (BOAS)

Brachycephalic dogs are anatomically predisposed to respiratory disease because of their stenotic nares and elongated soft palate. The changes in airway pressures can lead to everted saccules, gastroesophageal reflux disease, hiatal hernias, and, in end-stage disease, laryngeal collapse. Byers recommended that veterinarians “intervene as much as the owner will allow [as soon as possible]” to avoid progression of disease.

A strong suspicion of BOAS can be gained based on signalment, history, and physical examination. Dogs with this syndrome will often present with stertor and/or stridor and visibly stenotic nares. Approximately 25% of these dogs will also have a history of chronic retching, gagging, or vomiting.

 “If you see a brachycephalic patient presenting for [gastrointestinal signs], it is the airway until proven otherwise,” Byers reminded the audience. Definitive diagnosis of BOAS requires a sedated oropharyngeal examination to confirm an abnormal soft palate and assess for laryngeal changes, including paralysis and masses.

Many patients with BOAS may present acutely in respiratory distress. The goals of treatment are to improve airflow through the upper airway and reduce patient anxiety until definitive treatment can be pursued. This is accomplished by:

Providing oxygen through the least stressful modality, such as oxygen cage, flow-by, or nasal cannula.

Sedating patients to reduce anxiety and decrease the work of respiration. Byers recommended butorphanol and acepromazine in these cases.

In some cases, intubating patients to control the airway will be required.

Steroids can also be helpful in BOAS cases, but they are “not an emergency drug,” Byers said. An anti-inflammatory dose will help to reduce swelling, but it will take 3 to 4 hours to see this effect. Nebulizing epinephrine may provide a more rapid reduction in inflammation.

Finally, a temporary palatopexy can be performed in the emergency department to buy time until the patient can be taken to surgery. This procedure uses 1 to 3 sutures to temporarily tack the edge of the soft palate to the hard palate, thereby opening the airway.

Although there are medical options that can be used, surgery is the definitive treatment. Byers recommended that veterinarians “be proactive about surgery to reduce long-term chronic [airway] changes.”

Clients should be counseled about the potential risks of surgery and anesthesia. Byers noted that brachycephalic dogs have 4 times the risk of aspiration pneumonia compared with other patients, and 7% of these dogs will have postoperative complications. The Brachycephalic Risk (BRisk) score is an objective way to assess risk and provide data to help owners make the best decision for their dog.

This condition is seen most often in older, small-breed dogs. These patients have a congenital abnormality in the tracheal cartilage, which degenerates over time, resulting in the disease manifesting later in life. In most cases of primary disease, the cervical trachea is affected. Most patients present with a goose-honking cough that is exacerbated by activity or excitement. Sensitivity on tracheal palpation is suggestive of the disease but not definitive.

Diagnostic imaging provides a definitive diagnosis. Because the disease is dynamic in nature, plain radiographs may not be sufficient. Fluoroscopy and tracheoscopy or bronchoscopy may be required to obtain a diagnosis.

The primary goal of therapy is to reduce the cough. Byers noted that “getting rid of the cough completely is an unrealistic expectation,” but reducing the frequency and severity of coughing will improve quality of life for both patient and owner.

Numerous cough suppressants are available, but no one medication is superior to others. Byers’s personal preference is a combination drug of diphenoxylate and atropine (Lomotil; Pfizer Inc) that helps to dry secretions and decrease mucus production. In some cases, bronchodilators may be helpful. For patients with refractory disease, stenting can be performed as a salvage procedure.

Geriatric Onset Laryngeal Paralysis and Polyneuropathy (GOLPP)

Geriatric large-breed dogs are overrepresented in cases of GOLPP. The condition was previously called laryngeal paralysis, but 25% to 33% of these patients have polyneuropathies at the time of diagnosis. The disease is characterized by stridor and increased inspiratory effort. Some patients will present in respiratory distress, and many will have concurrent gait abnormalities such as stumbling or scuffing of the feet when walking.

Definitive diagnosis is obtained by performing a sedated laryngeal examination. A newer strategy to obtain the diagnosis is to use ultrasound to observe the movement of the cuneiform processes.

Like BOAS, patients with GOLPP need surgery for definitive therapy. Medical management is meant to be temporary and support patients until surgery can be performed. This includes sedation and anxiolysis, maintaining a healthy weight, and reducing exercise. The goal of surgery is to widen the glottis enough to allow adequate ventilation while maintaining enough glottic covering during swallowing to prevent aspiration.

Signalment, history, and physical examination findings are helpful in identifying the cause of canine upper respiratory disease. For patients with BOAS and GOLPP, medical management is meant to be temporary until definitive surgical treatment can be performed. In cases of tracheomalacia, medical management is prioritized, with surgical stenting reserved as a salvage procedure. Ultimately, early intervention provides the best outcomes for patients with all of these upper respiratory disorders.

, is a 2013 graduate of the University of Pennsylvania, a practicing veterinarian, and a freelance speaker and author in western Pennsylvania. She is passionate about mentorship, spectrum of care, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Boatright is actively involved in organized veterinary medicine.

Articles

Managing upper airway diseases in dogs requires making an accurate diagnosis and targeted treatment. 

Medical management of canine upper airway diseases

The Veterinary Hospital Managers Association (VHMA)has announced the recent certification of 25 veterinary management professionals. Each of these individuals have earned the Certified Veterinary Practice Manager (CVPM) designation.

The CVPM program’s class of April 2025 includes Kendra Blevins, Elizabeth Capo, Laura Carrillo, Kristyn Chen, Ronielle Cole, Jackie Condrea, Kari Dummer, Marjorie Holloway, Katrina Looker, Samantha Maloni, William Maxwell, Daria McKay, Michelle Mellinger, Damaris Miguel, William Mize, Jamie Nelson, Sarah Peterson, DeeDee Remington, Jennifer Rising, Shauna Saenz, Tara Denise Stephens, Denna Stevenson, Erica Svencer, Amber Westby and Dana Willer.

The VHMA provides training, education, and resources to more than 5000members. A trusted resource for veterinary industry insights, research, and advocacy, the VHMA's main goal is to advance and support veterinary practice management professionals by developing professional competence, while supporting, and encouraging standards through the CVPM program. VHMA also provides individuals with a network for professional connection and support.

The voluntary CVPM certification program is recognized as a sign of professional achievement and excellence, according to the VHMA. The designation is awarded to veterinary practice managers who demonstrate the knowledge and experience necessary to successfully manage the evolving operations of veterinary practices.

The CVPM certification program is recognized and respected by practice leaders and others in the veterinary industry, according to the VHMA

Before completing the CVPM exam, applicants are required to meet practice management experience requirements and demonstrate that they have earned sufficient formal education and continuing education credits. The rigorous CVPM exam— offered electronically across North America to registered candidates—tests relevant management knowledge in human resources, law and ethics, marketing, organization of the practice, and finance.

Veterinary practice managers earn prestigious CVPM designation. News release. Veterinary Hospital Managers Association. May 12, 2025.

These individuals have earned the CVPM credential

VHMA awards certification to 25 practice managers 

The FDA recently approved a gene-editing technology used to make swine resistant to porcine reproductive and respiratory syndrome (PRRS), a highly contagious disease for which there is no effective treatment. The technology, developed by the Pig Improvement Company (PIC), is among the first to receive FDA approval for the gene editing of commercial livestock in the United States and will be used to breed PRRS-resistant swine.

The FDA approval, which was granted on April 30, 2025, deems the technology to be safe and effective. The gene edit could provide a new tool for farmers and pork producers managing PRRS. “We have spent years conducting extensive research, validating our findings, and working with the FDA to gain approval,” Matt Culbertson, chief operating officer of PIC, said in a news release.

“Today marks a major milestone for consumers, farmers, and the entire pork industry who have desperately hoped for a solution to PRRS.”

In breeding animals, PRRS can cause reproductive impairment or failure, in addition to causing respiratory disease in pigs of any age, leading to premature death.

 The disease also suppresses the immune system of pigs, making these animals more prone to secondary infections that may require antibiotics.

PRRS is the most economically impactful disease in US swine production since classical swine fever was eradicated.

According to the American Veterinary Medical Association, the disease caused a loss of approximately $1.2 billion annually in the US pork industry production from 2016 to 2020, representing an 80% increase compared with the previous decade.

 Still, PRRS affects swine globally, particularly in major swine-raising countries.

Beyond its financial toll, PRRS affects animal welfare, increases the need for antibiotics, and raises the environmental footprint of raising swine. “Addressing PRRS can allow us to improve animal welfare and reduce the environmental impact of raising pigs,” Banks Baker, global director of product sustainability at PIC, said in a news release.

 “Recent research indicates that PRRS increases the need for antibiotics by more than 200%. Plus, a recent ISO [International Organization for Standardization]-conformant life cycle assessment found that eliminating PRRS could reduce greenhouse gas emissions by 5% in the US.”

According to PIC, Colombia and Brazil have “already issued positive determinations” for the technology behind PRRS-resistant pigs and will regulate them as they would any other pigs.

“We are committed to the responsible and intentional introduction of the PRRS-resistant pig around the globe,” Culbertson said.

 “Gaining FDA approval for the technology is an important step in this process, and we are working with additional countries to gain regulatory approval and protect global trade prior to initiating sales and delivery.”

PIC receives FDA approval for technology used to breed PRRS-resistant pigs. News release. Pig Improvement Company. April 30, 2025. Accessed May 16, 2025. 

https://www.pic.com/pic-receives-fda-approval-for-technology-used-to-breed-prrs-resistant-pigs/

Porcine reproductive and respiratory syndrome (PRRS). Iowa State University College of Veterinary Medicine. Accessed May 16, 2025. 

https://vetmed.iastate.edu/vdpam/about/focus-areas/swine/swine-disease-manual/index-diseases/porcine-reproductive#:~:text=PRRS%20is%20an%20acronym%20(porcine,in%20pigs%20of%20any%20age

FDA approves gene-editing tech creating PRRS-resistant pigs. American Veterinary Medical Association. May 6, 2025. Accessed May 16, 2025. https://www.avma.org/news/fda-approves-gene-editing-tech-creating-prrs-resistant-pigs 

The technology will be used to breed PRRS-resistant swine.


FDA approves gene-editing technology for swine

Vet Watch Update: NWS

, the New World screwworm. I get asked whether or not there is a realistic potential for this fly to be hitting the US in the next year or so. Well, let’s take a look at the math to help answer that question. In addition, we can take a look at some of the math on white-tailed deer to help explain the overall devastation that this fly can impart.

If we take a look at the white-tailed deer population in the 1940s and [1950s] and compare it [with] the 1970s—after New World Screwworm was eradicated—we are looking at nearly a 10-fold difference in increase in population. Now, the eradication of screwworm was not the only factor that helped the deer rebound, but it was a major factor in this change.

 from the US back in the [1960s]? Well, to understand that, 

, the New World screwworm, has an Achilles' heel—or Achilles tarsus, as it were. And that is that the female only has sex 1 time. Thus, if you can release irradiated, sterile males into the environment, when they have sex with the female, that female will no longer be able to produce viable eggs. And that is how it was done.

How many irradiated flies do you need in order to do this? Well, back in the 1960s, we had 3 laboratories producing 800 million flies per week—and that was out of the combined efforts of a laboratory in Panama; Mission, Texas; and Chiapa de Corzo [near Tuxtla Gutiérrez, Chiapas, Mexico]. And through that, we had 800 million. Well, what is being done now? Right now, the only one that is currently still working is COPEG in Panama. They are at max capacity, and they’re releasing up to 100 million pupae per week into the environment through ground boxes as well as air release.

And while we truly appreciate those efforts, that is not stopping the motion. We have been seeing New World screwworm moving up from South America, through every single country in Central America, and has touched down into Mexico. Currently, we are looking at the numbers nearly doubling every couple of weeks. It has gone from a couple of sightings of New World screwworm in Mexico, to dozens, to now over 400 different sightings of this fly in Mexico. Very scary. There are only 2 Mexican states separating confirmed New World screwworm cases from the US border.

So, what does this mean? Well, it means that invasion is likely. We are likely to see the New World screwworm here this year, if not next. It also means that there is the potential to create devastation—to our protein production, to our pets, to ourselves, and to the wildlife. Thus, we need to keep vigilant. If there’s any concern that you may be seeing this fly, there are many labs that will help identify maggots or adults.

Since our last New World screwworm video, cases in Mexico have surged past 1400. There is now only 1 Mexican state separating confirmed New World screwworm cases from the Texas border. And over the weekend, due to this, the US halted all cattle imports from Mexico—a move that could impact anywhere from 1.2 to 1.8 million head of cattle annually. That’s a major hit to our beef supply chain. And this isn’t just a foreign animal disease threat—it’s actively knocking at our door.

So stay alert, know how to recognize it, and do not hesitate to report any potential cases. Thank you for tuning in to Vet Watch, only at 

, where what you know today protects everybody tomorrow.

Videos

Amid a surge to more than 1400 confirmed New World screwworm cases in Mexico and an immediate US suspension of live cattle imports, Christopher Lee, DVM, MPH, DACVPM, warns this parasitic fly could breach the southern border by year’s end, posing serious risks to livestock, pets, wildlife, and even human health.

Vet Watch Update: New World screwworm

Fetch Nashville is officially 2 weeks away! As we get closer, we know everyone is reviewing the agenda to pick the sessions that they want to attend and the faculty they want to see. To help navigate the agenda, we have complied a short list of sessions to check out during the conference just for you!

Not registered for Fetch Nashville yet, there is still time. Check out the Fetch Nashville 

 to register today, plus see what else is happening at the show!

AI 101: Unlocking the Power and playing by the Digital Rules

Kick off Day 1 with this 7:00 AM lecture presented by Jennifer Guli, marketing director at Mount Laurel Animal Hospital in Mount Laurel, New Jersey to hear her give attendees a comprehensive understanding of artificial intelligence, including its applications and potential impact on the veterinary industry, plus how to utilize it to inspire creativity and innovation at your veterinary clinic.

Litterbox Lessons: Keeping Cats in the Litterbox

House soiling is a common medical and behavioral issue in cats—and a leading cause of surrender. From 10:45-11:45 PM, Tabitha Kucera, CCBC, RVT, KPA-CTP, VTS (Behavior), will cover key litterbox strategies, how do identify common triggers, and how to address the unique needs of senior or disabled feline patients. Through the lecture, attendees will also learn how to better support and educate clients through practical solutions to help keep the client and pets human-animal bond.

Transfusion Medical Considerations for the Hemoabdomen

After enjoying your complimentary lunch, from 1:15-2:15 PM Adesola Odunayo, DVM, MS, DACVECC, will give attendees an overview of the different blood types, products, and transfusion reactions veterinary professionals should consider when treating the hemoabdomen patient.

Converging on Consensus? New Recommendations for Diagnosis, Treatment, and Prevention of Leptospirosis

Jane Sykes, BVSc, PhD, MPH, MBA, FNAP, DAVCIM (SAIM), will review the 2024 American College of Veterinary internal Medicine Leptospirosis Consensus Statement recommendations and expert insights on what has changed. Each attendee will also learn the current day recommendations on diagnosing, treating, and handling suspect cases of Leptospirosis. This lecture will take place from 2:30-3:30 PM.

Kelly Detweiler and Peter Weinstein, DVM ,MBA, are one of the closing sessions for day 1, with their lecture taking place from 6:00 PM to 7:00 PM. In their lecture, this duo will review what happens when a DEA representatives come to your clinic and how to make the best first impression, since there is no second chance. Attendees will learn what to say and how you say it, what systems to have in place to make sure the right people know the answers to any questions, or where to find them, and more.

So, You Want to Be a Veterinary Technician Specialist (VTS) in Anesthesia

One of the lectures that is kicking of day 2 of Fetch Nashville at 7:00 Mike Barlette, DVM ,MS, PhD, DACVAA, Tasha McNerney, CVT, CVPP, VTS (Anesthesia & Analgesia), and Kristen Ward, BSN-RN, RVT, VTS (Anesthesia & Analgesia), will provide an overview of the requirements for being a Veterinary Technician Specialist (VTS) in Anesthesia and a Certified Veterinary Pain Practitioner (CVPP) as well as gain a step by step understanding of the credentialing process.

Diagnostics and Procedures: Tips and Tricks for the Exotic Animal Practitioner

Following the day 2 keynote address, Jeffrey R. Applegate Jr., DVM, DACZM, will encourage attendees to think outside of the box to and utilize creative ways to treat and monitor the nontraditional pets that come into your practice. Throughout the lecture, Applegate will offer attendees specialized techniques to help them elevate the standard of medicine for small, or difficult, exotic pet species.

Are no shows a problem at your practice? If so, join Wendy S. Myers, CVJ, from 1:15-2:15 PM to hear 4 strategies practice owners can implement into their practices to help end this costly, and rude, behavior. Myers will teach attendees when to send appointment confirmations and what they should say as well as a form for clients to completely in advance to secure their appoints, and more.

Choosing the right nutrition for each patient is complex, and so is understanding how pet food is made. This session presented by Taylor Root, VMD, will take attendees on a deep dive into the full lifecycle of pet food—from formulation by board-certified nutritionists to manufacturing, safety, and traceability. Attendees will explore how ingredients are selected, how processing methods affect nutrition, and how tools like the NOVA system and WSAVA guidelines support informed food choices. This lecture will take place from 2:30-3:30 PM.

Electrocardiography plays a vital role in managing cardiac conditions and monitoring anesthesia. William Rausch, DVM, DACVIM (Cardiology) will cover the essentials of interpreting canine and feline ECGs, along with advanced diagnostic insights. During the lecture, Rausch will show real case examples to highlight how ECGs provide critical information for clinical decision-making. Rausch will begin his lecture at 4:00 PM ET.

To close out the conference, Adam Christman, DVM, MBA, chief veterinary officer, dvm360, will join 7 other faculty members, including Christopher Pachel, DVM, DACVB, CABC, Fred Wininger, VMD, MS, DACVIM (Neurology), and Shadi Ireifej, DVM, DACVS-SA, to test help attendees put their knowledge to the test with this game show style event. Attendees will team up with Fetch Faculty and fellow colleagues to compete for prizes, and earn continuing education credits along the way. This is an event you do not want to miss, so join us and see which team is crowned the Ultimate Fetch Fanatic Champion.

Here are some of the lectures you will find at the upcoming Fetch conference

Fetch Nashville 2025: Session sneak peek

This content is sponsored by Antech Diagnostics.

, our host Adam Christman, DVM, MBA, welcomes special guest Kelly Mitchell, DVM, DVSc, Bsc, DACVIM (SAIM), to discuss all things feline heartworm. Throughout the episode, Mitchell highlights the need for a multimodal approach to testing, limitations of microfilaria testing in feline patients, treatment focusing on managing clinical signs and support care, and why prevention is crucial. 

Below is a partial transcript, edited lightly for clarity. 

The presentation that cats present for heartworm is definitely different [from] that of dogs. So at a practical level, how is heartworm's clinical presentation different in cats vs dogs?

Kelly Mitchell, DVM, DVSc, Bsc, DACVIM (SAIM

 Cats are not the natural definitive host for heartworm, and that results in a few differences in the pathophysiology of their disease, and a few...important differences when we compare them [with] dogs. Infection intensity in cats is often lower, so maybe only 1 to 2 worms and single-sex infections are thought to be more common in cats as compared [with] dogs. Now, considering cats [have a] generally smaller body size, the American Heartworm Society guidelines emphasize that even 1 to 2 [worms are] going to represent a significant infection burden in a cat. But to your point...the clinical signs of infection in cats are also very different than dogs, and I think in part, it leads to how this is a more elusive or difficult diagnosis in cats. So the clinical signs [in] cats [are] going to range from the obvious and the significant to the more subtle and nonspecific. 

While we certainly want to be cognizant of the obvious and the significant—those are going to include sudden death or a per-acute syndrome of severe respiratory or neurological signs, and sometimes cats will show clinical signs related to aberrant worm migration. Those are the obvious and the significant, but what we don't want to forget about are the subtle and the nonspecific. So, signs of chronic respiratory disease are most common, [such as] cough [and] increased respiratory effort or rate. Cats may also show nonspecific signs, [such as] lethargy, anorexia, vomiting, weight loss—clinical signs that can also be intermittent, right?

Thinking about it from that big picture, we do want to make sure that we're cognizant of these more subtle clinical signs and the differences between cats and dogs, just so that it's always on our list.... If we're not thinking about it, then we're going to miss that opportunity to diagnose it.

Podcasts

Learn more on heartworm in feline patients, plus what has been updated in the American Heartworm Society guidelines on this episode of The Vet Blast Podcast, presented by dvm360.