Shih Tzu Tracheal Collapse – The Facts

Shih tzu tracheal collapse examination.

If you are the parent of a shih tzu, tracheal collapse is a medical condition that you should be aware of. There is a significantly higher incidence of tracheal collapse in small breed dogs than in larger dogs. As well as the shih tzu, breeds such as the chihuahua, lhasa apso, Maltese, Pomeranian, pug, toy poodle and Yorkshire terrier are more commonly affected by this issue than other breeds.

How Common Is Shih Tzu Tracheal Collapse?

This higher rate of affected dogs is thought to be due to in-breeding over the centuries to produce these standard breeds that exist today. Originally, dogs naturally weighed between 40-pounds (18kg) and 50-pounds (23kg). 

Put simply, by way of in-breeding continuously through the generations, mating the smallest male with the shortest snout from one litter with the smallest female with the smallest snout from another, a short-snouted smaller breed of less than 16-pounds (7kg), sometimes much less, is created.

Unfortunately, this selective breeding has unintentionally left all of the aforementioned small breeds prone to having weakened cartilage in their windpipes.

The Trachea Defined

To better understand tracheal collapse, I’ll first expound on exactly what a trachea is, does, and how it functions.

Trachea is the technical term for the windpipe. It transports inhaled air from the nose and mouth, passing through the throat to the lungs, and then transports the exhaled air in the reverse direction.

The trachea consists of muscular tissue that is connected by rings of cartilage that give it a similar appearance to a vacuum cleaner hose. Only these rings are not completely circular. They resemble a letter “C” that covers 83% of the circumference. The open part of the “C” faces up towards the dog’s back.

The remaining 17% of the circumference consists of a thin membrane of tissue that closes up the open end of the “C’. This is known as the dorsal tracheal ligament, though it is more usually referred to as the tracheal membrane, or the dorsal membrane.

The front portion of the trachea is located in the throat area, while the remainder resides in the chest cavity.

Tracheal Collapse – Why It Happens

Sometimes puppies are born with a genetic defect that causes the cartilage C-rings not to form correctly. The defective cartilage may have less than normal amounts of composite components such as calcium, chondroitin, glycoproteins, or glycosaminoglycans.

More commonly, though, tracheal collapse occurs when the cartilage weakens with age. Usually, middle-aged to senior dogs, 4-years to 14-years-old are the most likely to suffer.

Cross-section of a collapsing trachea, showing the damage to the cartilage and the collapsing dorsal membrane.

Air that is on the move is of a lower pressure than the still air surrounding it. So, when a dog with a forward tracheal collapse breathes in, the air moving through the throat end of his windpipe at a lower pressure causes the dorsal membrane over the weakened cartilage to become flimsy and collapse under the higher, external pressure.  As the dog exhales, the membrane balloons out again.

If the weakened cartilage is in the chest section of the trachea, the exact opposite occurs. The dorsal membrane balloons out on inhalation and the collapse happens when the dog exhales.

If the weakened cartilages are all along the length of the trachea, then both inhaling and exhaling will cause the collapse.

In some cases of dogs with tracheal collapse, the bronchi, the smaller tubes connecting the trachea to the lungs, also collapse making breathing even more difficult and adversely affecting the dog’s response to treatment.

Symptoms Of Tracheal Collapse

The severity of tracheal collapse ranges from Grade I for the slightest collapse to Grade IV for the worst cases.

Dogs in the Grade I category may show no signs of tracheal collapse at all. The condition may go undiscovered until the dog begins coughing due to another issue. Certain conditions that will require a medical examination, for example, coughing due to kennel cough, respiratory infection, an enlarged heart, environmental factors such as cigarette smoke or dust, allergies, or obesity could lead to the discovery of a Grade I tracheal collapse.

Dogs unfortunate enough to be in the Grade IV category will probably develop a severe cough as they struggle to draw air through what is, in effect, a tube similar in cross-section to a flattened straw. 

The cough emitted by a dog with tracheal collapse is likened to a goose honk and often mistaken for reverse sneezing, which it most definitely isn’t. Although the cough may be singular, typically there will be a series of coughs with, perhaps, gagging and retching at the end.

The cough is non-productive, that is it is dry and there is no phlegm, but there may be some foam or yellow bile emitted from the gagging and retching at the end of the bout. 

There is often a trigger that will start off a bout of coughing. These triggers include stroking the dog’s throat, pressure placed on the throat, say when a dog wearing a collar pulls on the leash or when the dog is picked up by the collar, when the dog gets excited, eating and drinking, and exercise, especially in hot and humid weather.

If your shih tzu has these bouts of coughing, it’s not necessarily a cause for alarm. As long as his breathing is normal and is not labored, and his gums and tongue are the usual pink color, there is no immediate concern. At worst, your shih tzu is probably feeling an irritating tickle in the throat.

However, if the breathing is more labored and the gums and tongue are turning a blue or bluish grey (cyanotic) color, then there is reason to consult your vet as soon as possible.

Tracheal Collapse Is Progressive

A vet carrying out an examination of a shih tzu.

There is no total cure for tracheal collapse but the condition can usually be managed with medical treatment or, in the most severe cases, eased with surgery.

It’s a progressive disease where the weakened cartilage rings become increasingly so over time.

The condition becomes a vicious circle for the dog. The coughing bouts lead to anxiety which, in turn, leads to more coughing bouts. Panting and gasping for breath also brings on anxiety, leading to more panting and shortness of breath.

Long term breathing difficulties from tracheal collapse can bring on secondary conditions such as heart disease and laryngeal paralysis. Dogs with the latter issue usually wheeze on inhalation.

Any signs that your shih tzu is extremely stressed and struggling to breathe should be considered a medical emergency and you should take him to your vet or nearest animal hospital as soon as possible.

Diagnosis Of A Tracheal Collapse

If your shih tzu is exhibiting the symptoms of a tracheal collapse, to avoid receiving the incorrect treatment it’s important to obtain an exact diagnosis of his condition as the same symptoms are also true of several other medical issues. 

Some of these issues include canine infectious respiratory disease, also known as CIRD or kennel cough, laryngeal paralysis, tracheal infection, lung infection, a foreign body obstructing the airway, an elongated soft palate, heart disease, congestive heart failure, and tumors or polyps.

A vet stroking a shih tzu’s throat to see if there is any reaction.

When you first take your shih tzu to the vet with suspected tracheal collapse, he may initially apply slight pressure to your dog’s throat to discover if he reacts by coughing or if he gets into breathing difficulties, the typical signs that a tracheal collapse may be present.

If this is the case and the vet suspects that this is the issue, he may then call for a traditional X-ray to confirm his suspicions and to discover exactly where along the trachea the damage is and how severe it is. 

The advantage of radiography to begin diagnosis is that it is non-invasive and doesn’t cause any further stress for the dog. The main disadvantage with an X-ray is that it is a snapshot of one moment in time. If when the X-ray is taken a dog with a throat-end collapse is breathing out, or a dog with a chest-end collapse is breathing in, the damage may not show up at all.

To literally get a better picture of the trachea, a fluoroscopy may be called for. A fluoroscope takes a series of X-rays that give a real-time moving image of the object, in our case the trachea, in action. 

This enables the viewer to observe exactly where the trachea is collapsing as it is collapsing, and by how much and the extent to which the cartilage is damaged as the dog breathes in and out. 

As with radiography, fluoroscopy is non-invasive. The dog is placed on the table in a transparent plastic box while a C-arm containing the X-ray equipment arcs over him. If the dog is agitated he may be sedated a little but is kept conscious so that he can be coaxed into sitting or lying in the correct position. 

A shih tzu lying in wait for a fluoroscopy.

If the vet needs to take a look from the inside, he may commission an endoscope, a tiny camera attached to a cable, to perform a tracheoscopy, bronchoscopy, or both.

For this procedure the dog is anesthetized before the endoscope is passed through the mouth into the trachea and bronchi. The pictures sent back enable the vet to see the trachea in action and he can visually see if there is any collapsing happening as well as any evidence of inflammation or irritation.

While the vet has the endoscope inserted in the windpipe and he suspects there could be other respiratory problems, he may take some samples to examine afterwards under the microscope. The aim of this is to discover if there are any organisms (such as bacteria, fungi, or viruses), or another disease present that may be complicating the condition.  

One test involves using sterile fluid to flush the trachea and collect organisms and cells from the wall of the trachea. This process is termed “transtracheal wash”, or  “bronchoalveolar lavage”.

A similar type of test utilizes a small brush to rub the tracheal lining rather than a fluid to collect the specimens. This is known as “brush cytology”.  

Or the vet may use a tiny surgical instrument to perform a biopsy, gently cutting tiny samples of tissue from the tracheal lining where it appears there may be an issue.

Treatment For Shih Tzu Tracheal Collapse

If diagnosed early enough, and with the less severe cases, the condition can be treated using only medical management methods. The more progressed and severe cases may need surgery, or a combination of surgery and medical management. Whatever treatment is recommended by the vet, the patient is very likely to continue to suffer from coughing to some degree for life.

Medical Management – What You Can Do

The two prime targets for medical management of tracheal collapse are to suppress the cough as much as possible and to reduce any inflammation of the airways. 

Before we come to using any actual medication, changes to your shih tzu’s environment should also be considered, as well as taking action to reduce stress on his trachea.

A shih tzu on the scales checking for weight issues.

First, and most important of all, if your shih tzu is overweight, a change to a controlled diet will be necessary in order to shed the excess pounds. Carrying excess weight forces the respiratory system to work harder to draw in enough oxygen to be moved around the body. If the weight is brought down to normal, less oxygen is required and breathing becomes less labored. This means less stress is placed upon the trachea.

Then, there are other actions you can take to help your collapsing trachea patient lead a more comfortable life such as to improve the ambient air quality around the vicinity of your shih tzu’s usual surroundings, cutting down on the more strenuous exercise and exchanging a collar for a harness. I expand more on these points towards the end of this report.

Medical Management – What Your Vet May Prescribe

Medication will vary from case to case, depending upon what other issues are involved, and from dog to dog. Some shih tzu will need constant treatment, others only sporadically. 

The main symptom of tracheal collapse, the goose honk-like coughing, causes irritation of the trachea and further anxiety for the unfortunate shih tzu. This irritation and anxiety leads to more coughing, creating a vicious circle. It follows, then, that it is important to break this cough-anxiety-cough cycle.

For this reason, and if the dog is also suffering from secondary issues such as bronchitis, the vet may prescribe cough suppressants. These can be assisted by anti-inflammatories to reduce any swelling inside the airways, and sedatives to help alleviate anxiety. Should any infections be present in the respiratory system, a short course of antibiotics may also be prescribed.

If the collapse is towards the chest end of the trachea, the vet may give bronchodilators to open up the bronchi somewhat and make the dog’s breathing easier.

In cases where the collapse is severe enough to cause respiratory distress, treatment may include sedation to calm the dog, steroids to reduce any inflammation of the trachea, and supplemental oxygen to restore adequate levels. In more severe cases a breathing tube may need to be inserted with the dog under anesthetic.

Alternative Medicine

A holistic veterinarian may use the best combination of conventional and holistic medicines to achieve the best improvement in a dog’s condition.

Chondroitin, glucosamine and MSM (Methylsulfonylmethane) are three cartilage builders that may be prescribed either individually or in combination. 

Alternative medicine for shih tzu tracheal collapse.

I have personal experience with this treatment as it made a great improvement in the condition of my knees after being diagnosed with osteoarthritis. So I can understand that it could also help reinforce tracheal cartilage in a dog.

Other cartilage that may come into consideration are green lipped mussel (perna canaliculus), CMO (cetyl myristoleate) and eggshell membrane.

Some improvements may be gained by feeding the dog with whole foods that contain trace mineral elements of silica or manganese, or by adding these as supplements to his normal food. 

The addition of natural anti-inflammatories like turmeric or proteolytic enzymes may also bring improvements.

Also known to have been effective in alleviating the intensity and length of coughing fits, and perhaps therefore worth consideration are the practices of acupuncture, Chinese medicine, chiropractic, and homeopathy.

Of course, as with any conventional medicine, consult with your vet before embarking on any of these therapies.

When Medical Management Isn’t Enough

Medical management is effective at managing the condition in about 70% of dogs diagnosed with a collapsing trachea and any secondary issues. 

If the medication produced results for a time and now no longer has any effect, it may be that the dog has become immune to the treatment. In this case, a simple change to an alternative course of medication may provide the answer.

For the 30% of unfortunate dogs that just cannot gain enough improvement from medication and their condition becomes life-threatening, then surgery is the next consideration.

All tracheal surgery is extremely intricate and complicated. As such, it should only be attempted by a suitably qualified veterinarian with the relevant skill set and experience. Because of the nature of this surgery, it should only be performed where medical management has failed and the condition has become life-threatening.

Surgical Implant Of Tracheal Rings

If the condition becomes seriously life-threatening and the collapse is at the front end of the trachea, the surgeon may suggest implanting prosthetic polypropylene rings to support the weakened cartilage. These are usually fixed to the inside of the trachea but in some cases may be placed on the outside.

The surgical procedure to fit these rings is extremely complex, but success rates are high thanks to modern materials and techniques.

Surgical Use Of A Tracheal Stent

A tracheal stent as may be used in severe cases of collapsing trachea.

The least complicated and least invasive form of surgery is to place a self-expanding, woven wire mesh stent inside the windpipe along the affected area. The placement is made during a fluoroscopy enabling the vet to set the stent in the correct location.

Although this doesn’t do anything to actually repair the collapse or alleviate the bouts of coughing, it does ensure that the patient’s airway is kept open for the life of the stent. Medical management will probably then continue to be needed to work in conjunction with the stent to provide relief from coughing and any other symptoms. 

Tracheal stents have a limited working life and will eventually need to be replaced. They are also prone to complications. Possible complications include a fracture or movement of the stent causing further irritation to the airway, tracheal rupture, infection of the airway or lungs, laryngeal paralysis, granulation tissue formation, and collapse of the non-stented section of the trachea or the main stem bronchi. There is also a very small risk of the dog dying during or after placement of the stent.

Placement of a tracheal stent is not advisable for dogs whose condition is being successfully managed by medical means or have less than 50% collapse. A stent is also not advisable for dogs with severe bronchial collapse, uncontrolled respiratory infection, or any other serious illness.

Associated Liver Disease

A study in the USA has ascertained that liver disease may follow as a consequence of a collapsing trachea. The study assessed the liver functions of 42 healthy dogs with 26 dogs suffering tracheal collapse. It was found that 24 of the 26 dogs with tracheal collapse, that’s around 92%, had abnormal liver function test results.

The conclusions of this study were that this is due to the restricted oxygen supply resulting from the constricted airways and that dogs with a collapsing trachea or other respiratory disease should be routinely tested for liver malfunction. 

Dogs fitted with tracheal stents to open up their airways showed improvements in their liver test results.

SOURCE: The Journal Of Veterinary Internal Medicine

What The Future Holds For Shih Tzu With Tracheal Collapse

It is true to say that a shih tzu with a tracheal collapse that can be adequately managed exclusively by medicinal treatment will have a much better chance of living a full and reasonably active life than one that has to undergo surgery.

However, there are lifestyle changes that you can make that will benefit any affected shih tzu and help them to live a more comfortable life.


Keep the air surrounding your shih tzu’s environment as pure and particle free as possible. Certainly keep the area clear of cigarette smoke and fresh-air sprays or plug-ins, as these add more particles to the air. Not only can more particles in the air irritate the airway, but they also fill the space oxygen previously occupied making things worse for the already oxygen-starved dog. 

However, air filters and air purifiers that actually provide cleaner air by removing unwanted particles are a good choice if you can fit them.

Leaving a window or two open, even just a little, will help improve the air quality by allowing it to circulate and replenish itself.

If your shih tzu sleeps on a bed imported from China, consider replacing it with a high-quality model. The imported beds are typically coated in PBDE (polybrominated diphenyl ethers) plastic for fire resistance.  PBDE is known to be toxic, especially if exposed to it over a period of time.

Here’s an example of a suitable bed. This one is available from Click on the affiliate link for more information. 

3 Dog Pet Supply EZ Wash Orthopedic Bolster Bed modeled by Bruno.

3 Dog Pet Supply EZ Wash Curler Orthopedic Bolster Bed

If you want one of these beds, be sure to select the “small” option for a cosy fit for your shih tzu.

Keep Your Shih Tzu Calm And Cool

As you probably know, dogs pant to regulate their body temperature during hot days. When they are panting they are drawing in extra gulps of air which puts extra pressure on a collapsing trachea. 

So, try to keep your shih tzu in a cool, shady space when experiencing hot weather. An air-conditioned room is ideal.

For a shih tzu with tracheal collapse cut back on exercise intensity.

Similarly, strenuous exercise and hyper-activity will lead to heavier breathing and extra strain on a weakened trachea. All dogs need exercise, including those suffering from a collapsing trachea. For these dogs, gentle exercise will cause less distress.

In hotter weather, it’s beneficial to the dog to take walking and exercise early in the morning and just before sunset, usually the cooler times of daylight hours.

Don’t leave your shih tzu alone in the car at all, even if the weather doesn’t seem that hot. You should never do this with even a healthy dog, let alone one with breathing issues. Even with a window open, a parked car can turn into an oven very quickly.

Try and keep your dog away from situations that set him off on a barking session or that get him overexcited, such as when the doorbell rings, for example. Barking sessions and the resultant rapid breathing from overexcitement can irritate the trachea which, in turn, can bring on a long bout of coughing.

To enable muting the ring of the doorbell that triggers the bout of overexcitement, it may be worth considering a doorbell that links to your smartphone or smartwatch to let you know when someone is at your door. Something like this one, which is available from Amazon:

Amcrest 1080P Video Doorbell Camera

Click on the affiliate link above to learn more about this item on the Amazon website.

My younger shih tzu, Charlie, becomes very excited when I return home and often begins a series of goose-honk coughs as a result. Initially, I made the mistake of thinking this was reverse sneezing, but now I believe that he has a mild, genetic tracheal collapse. 

Because of this, I am now working on training him not to become so excited when I come home. I also found that by stroking his throat in attempt to calm him down, it actually made the coughing worse. So now when he starts coughing I try to calm him by stroking his head and massaging behind his ears. This approach appears to be more effective.

I mention this in the case that it may help others whose shih tzus have a similar issue.

Avoid Unnecessary Pressure On The Trachea

If your shih tzu wears a collar for attaching a leash, it would be very beneficial for him if you exchange this for a harness, whether he is suffering from collapsing trachea or not. 

I am specifically thinking of the type of harness with a padded chest section designed to keep the pressure caused by straining or pulling on the leash off of the throat and trachea area and instead spread it more evenly over the stronger, chest area.

For more about harnesses, see my report:

Dog Collars For Shih Tzus – Is A Harness Better?

Change For The Better

So there we have it. Tracheal collapse can never be completely cured but we can do what we can to make our affected dogs more comfortable.

Medical management, environmental changes and lifestyle changes can collectively make a huge difference to the patient’s quality of life. 

In some cases surgery may be a necessary option and when this does prove to be the case we shih tzu parents must redouble our efforts to help our charges lead as good a quality of life as possible.

If you have an queries about this topic or about anything else shih tzu related, please leave a comment below. Alternatively, you can use our contact us form to send a message.

Bye for now.

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