Hi Dr. Barchas,
I read your article on collapsing trachea. We just found out that our dog Bear (he is 8) has a collapsing trachea. Your article gave me a lot of hope, but I am still scared and worried.
We love him so much; he is a great dog. My vet put him on steroids, but in your article you said it might not be good for him. Is there any other medication you can tell me about that might be better? And will he live without surgery to his full lifespan?
Collapsing trachea is a syndrome that is common in middle-aged and older small dogs. It occurs when rigid structures in the trachea (the windpipe) lose their strength and cause it to cave in or collapse. Mild cases cause a tickle in the throat that leads to coughing, especially when the dog is excited or when his throat is compressed by a collar. Severe cases are not common, but can lead to breathing difficulties that can be life-threatening.
Collapsing trachea is diagnosed through physical exam and X-rays.
The most basic treatments do not involve medications. Since obesity dramatically complicates collapsing trachea (and all respiratory problems), it is crucial that dogs with this condition maintain a healthy weight. They should be walked with harnesses rather than neck leads to prevent compression of the trachea by the collar. They also should avoid heavy activity and excitement on hot days, because heat markedly increases the amount of work that is required of the windpipe. It also is important to identify and treat other conditions (such as heart conditions and lung infections) that can cause similar symptoms and that are also common in dogs that are prone to collapsing trachea.
These simple measures have been sufficient to control collapsing trachea for life in the majority of dogs that I have met. However, it is a progressive disease, and more severely affected dogs may need other treatment. The most basic medications used are cough suppressants that do not treat the underlying collapse, but they often suppress symptoms sufficiently to allow dogs to return to good qualities of life.
The use of steroids such as prednisone is controversial. It may reduce inflammation in the trachea caused by collapse, but it will not prevent the collapse itself. Long-term prednisone use is virtually certain to lead to side effects, and is of questionable value in the treatment of collapsing trachea. I generally do not prescribe steroids for collapsing trachea.
There is a form of surgical intervention, called stenting, which involves the placement of a rigid structure into the windpipe to hold it open. Great progress has been made in the efficacy of this procedure over the last decade, but it still has pitfalls. Namely, the stents are prone to failure over time so the procedure often must be repeated after several years. It must also generally be performed by a specialist, and that of course means that it is expensive. However, it is a good option for some severely affected dogs.
Michelle, I doubt that Bear will require the more aggressive treatments. I recommend that you start with the simple things: weight management, a harness, and avoidance of activity on hot days. Revisit the steroids with your vet to see whether they’re really necessary.