Brachycephalic Syndrome in Cats

Brachycephalic syndrome may involve several upper airway abnormalities. Cats with this health issue may have an elongated soft palate, stenotic nares (narrow, pinched nostrils), and everted laryngeal saccules (small sacs in the larynx that turn out). All of these obstruct normal air flow. Some cats may also have narrowed tracheas or hypoplastic tracheas.

Cats that develop brachycephalic syndrome typically have shortened skull bones and short, pushed-in noses. “Brachycephalic” comes from two words, with “brachy” meaning shortened and “cephalic” meaning head. It’s this appearance that leads to this cat’s health issues. With the shortened nasal passages of this cat, it develops  breathing problems, along with other health issues. The cats most likely to develop brachycephalic syndrome are Himalayans, Persians and Burmese cats. They have been bred so that these facial features are more visible.

The cat with brachycephalic syndrome shows several characteristic symptoms that all combine to make breathing difficult:

• Mouth breathing
• Noisy breathing
• Snoring
• Labored breathing
• Snorting noises
• Fainting after exertion
• Tiring with physical activity
• Restlessness
• Coughing and gaging
• Frequent retching or vomiting
• Cyanosis 
• Worsening symptoms during hot weather

Because of the cat’s facial features and breathing issues, it may also have additional symptoms and issues:

• Difficulty swallowing
• Higher risk of heat stroke
• Dental and periodontal disease
• Skin infections in the folds of its face
• Abnormal body posture from attempts to breathe more efficiently
• Eye problems

Brachycephalic syndrome has only a few causes:

• Cats that are bred to have shortened faces
• Narrowed nostrils
• Long soft palate
• Turned-out laryngeal saccules
• Hypoplastic (narrower than normal) trachea

Breeders prefer this shortened head shape in several cat breeds, but this leads to significant health issues for those cats.

Once a cat has begun to display symptoms, it can be easy for the vet to develop a diagnosis, but they will still want to run several diagnostic tests to make sure it is correct. The vet may recognize the cat’s appearance and ask about any unusual symptoms the owner may have noticed, such as fainting, noisy breathing or difficulty breathing.

Vets know that certain purebred cats are more likely to have been bred to have the shortened face. Knowing this, they will examine the cat, noting its facial characteristics. The vet will also visually inspect the cat’s palate and look for the turned-out laryngeal sacs. This may need to be done while the cat is under anesthesia.

Because cats with brachycephalic syndrome don’t always tolerate anesthesia well, the vet will order chest X-rays and blood work to determine the cat’s overall health before beginning anesthesia. While the cat is under anesthesia for the diagnostic work, the vet will also recommend that surgery be done at the same time. By combining the diagnostic work and surgery into one procedure, this reduces the risk to the cat’s life.

The vet will specifically look at the cat’s CO2 and pH levels when they order blood work. This helps them to understand the extent of the cat’s breathing problems. The cat may also undergo an endoscopic examination of the trachea and upper airway to see how severe the airways and trachea are affected by this syndrome. Finally, the vet orders bacterial cultures or a biopsy of the airway to identify any potential infections the cat may have.

Treatment of brachycephalic airway syndrome begins immediately because of its effects on the cat’s health and life. If the cat is overweight, the vet wants to see the cat can lose the unneeded weight. By losing excess pounds, the cat will find it easier to breathe and, eventually, to move around more easily.

The cat may begin taking non-steroidal anti-inflammatory (NSAIDS) medications to help give short-term relief from respiratory distress and airway inflammation. Corticosteroids can give the cat the same type of relief from its symptoms. Oxygen therapy allows the cat to get more oxygen into its airways and body. These only help to manage symptoms, not correct their causes.

Surgery is the best option to help the cat get needed, permanent relief. The veterinary surgeon widens the cat’s nostrils by removing a small wedge of tissue. The soft palate is shortened, making it much easier for the cat to breathe post-surgery. Finally, the turned-outward laryngeal sacs will be removed, further removing obstructions to the cat’s airway. The earlier the cat is diagnosed with brachycephalic syndrome and surgically treated, the better. This prevents the cat from developing other abnormalities related to its shortened face.

The vet also recommends that, at home, the owner limit the cat’s exercise. The owner will also need to help the cat by reducing its stress levels. Enabling the cat to stay cool during hot weather also helps to prevent avoidable symptoms.

Once brachycephalic syndrome has been diagnosed and treated in a cat, its overall prognosis should be good, depending on how many abnormalities have been corrected and the age of the cat.

It’s better for the cat to be treated at a younger age before other health issues develop. Also, if the cat has fewer anatomical abnormalities to correct, the cat will have a better recovery and outlook. If the cat also has a hypoplastic trachea, its prognosis for overall recovery may not be as positive. If the cat has any additional breathing issues, such as allergies that lead to breathing distress or secondary issues, their prognosis is also poorer. 

For older cats whose elongated palates have already begun to stiffen or collapse, the prognosis is usually not positive.