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pets_doc
pets_doc, Dog Veterinarian
Category: Dog Veterinary
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Experience:  Senior Emergency Veterinarian for 7 years, General Practitioner for 11 years, DVM in Florida, BSAPS
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My dog is making breathing sounds like he is choking

Customer Question

My dog is making breathing sounds like he is choking.

He makes an attempt to vomit but nothing comes out.

He is not eating and will drink very little.

Submitted: 6 years ago.
Category: Dog Veterinary
Expert:  pets_doc replied 6 years ago.

Does he sound like a snorting pig? or does it sound more like a hacking or duck like honking sound?

The snorting sound is usually known as a reverse sneeze, caused by irritation in the back of the nasal cavity. The honking sound may indicate a collapsing trachea.

It is also possible that he may be exhibiting signs of Bordatella infection (more commonly known as kennel cough).

Below is further information regarding this question.

Reverse Sneezing (Pharyngeal Gag Reflex)

Authored by: Becky Lundgren, DVM

Reverse sneezing is a disconcerting event in which a dog makes unpleasant respiratory sounds that sound like it is dying -- or will die in the next few minutes. Reverse sneezing sounds similar to the honking noise made by a dog with a collapsing trachea, but reverse sneezing is a far simpler condition that usually does not need any treatment. It is called reverse sneezing because it sounds a bit like a dog inhaling sneezes. The sound the dog makes can be so scary that many owners have rushed in a panic to emergency clinics in the middle of the night.

The most common cause of reverse sneezing is an irritation of the soft palate and throat that results in a spasm. During the spasm, the dog's neck will extend and the chest will expand as the dog tries harder to inhale. The problem is that the trachea has narrowed and it's hard to get the normal amount of air into the lungs.

Anything that irritates the throat can cause this spasm and subsequent sneeze. Causes include excitement, eating or drinking, exercise intolerance, pulling on a leash, mites, pollen, foreign bodies caught in the throat, perfumes, viruses, household chemicals, allergies, and post-nasal drip. If an irritant in the house is the cause, taking the dog outside can help simply because the dog will no longer be inhaling the irritant. Brachycephalic dogs (those with flat faces, such as Pugs and Boxers) with elongated soft palates occasionally suck the elongated palate into the throat while inhaling, causing reverse sneezing. Small dogs are particularly prone to it, possibly because they have smaller throats.

Reverse sneezing itself rarely requires treatment. If the sneezing stops, the spasm is over. Oftentimes, you can massage the dog's throat to stop the spasm; sometimes it's effective to cover the nostrils, which makes the dog swallow, which clears out whatever the irritation is and stops the sneezing. If the episode doesn't end quickly, you can try depressing the dog's tongue, which opens up the mouth and aids in moving air through the nasal passages. Treatment of the underlying cause, if known, is useful. If mites are in the laryngeal area, your veterinarian may use drugs such as ivermectin to get rid of the mites. If allergies are the root of the problem, your veterinarian may prescribe antihistamines. Because reverse sneezing is not a severe problem, do not worry about leaving your dog home alone; if it occurs when you're not there, the episode will most likely end on its own.

If reverse sneezing becomes a chronic problem rather than an occasional occurrence, your veterinarian may need to look up the nasal passages (rhinoscopy), and may even need to take a biopsy to determine the cause of the problem. Sometimes, however, no cause can be identified.

Some dogs have these episodes their entire lives; some dogs develop the condition only as they age. In most dogs, however, the spasm is a temporary problem that goes away on its own, leaving the dog with no after-effects.

Cats are less likely to reverse sneeze than dogs are. However, owners should always have the veterinarian examine the cat in case it's feline asthma, and not a reverse sneeze. Feline asthma requires more treatment than reverse sneezing does.

Kennel Cough

(Infectious Tracheobronchitis)

What is it?

Kennel cough is a bronchitis characterized by a harsh, hacking cough which most people describe as sounding like "something stuck in my dog's throat." It is analogous to a chest cold for humans and is only a serious condition in special circumstances (see below); in general, it resolves on its own.

How Does Infection Occur?

The normal respiratory tract has substantial safeguards against invading infectious agents.

The most important of these is probably what is called the mucociliary escalator. This safeguard consists of tiny hairlike structures called cilia, which protrude from the cells lining the respiratory tract, and a coat of mucus over them. The cilia beat in a coordinated fashion. Debris, including infectious agents, get trapped in the sticky mucus and the cilia move the mucus upward towards the throat where the collection of debris and mucus may be coughed up and/or swallowed.

The mucociliary escalator is damaged by the following:

  • shipping stress
  • crowding stress
  • heavy dust exposure
  • cigarette smoke exposure
  • infectious agents (viruses such as reovirus, adenovirus, parainfluenza virus, and even the distemper virus can be initiating infections)
  • Cold temperature
  • Poor ventilation

Without this protective mechanism, invading bacteria, especially Bordetella bronchiseptica may simply march down the airways unimpeded.

Bordetella bronchiseptica has some tricks of its own as well:

  • It is able to bind directly to cilia, rendering them unable to move within 3 hours of contact.
  • It secretes substances that disable the immune cells normally responsible for consuming and destroying bacteria.

Because it is common for Bordetella to be accompanied by at least one other infections agent (such as one of the viruses listed above), kennel cough is actually a complex of infections rather than infection by one agent.

Classically, dogs get infected when they are kept in a crowded situation with poor air circulation but lots of warm air (i.e., a boarding kennel, vaccination clinic, obedience class, local park, animal shelter, animal hospital waiting room, or grooming parlor). In reality, most causes of coughing that begin acutely in the dog are due to infectious causes and usually represent some form of kennel cough.

THE INCUBATION PERIOD IS 2 TO 14 DAYS

How Contagious is it?

Bordetella infection can be picked up by rabbits, guinea pigs, pigs, cats (if they are very young and housed in groups), and other dogs. It is not contagious to humans though it is closely related to Bordetella pertussis, the agent of whooping cough. Among dogs it is fairly contagious depending on stress level, vaccination status, and exposure to minor viruses.

My hospital recommends keeping all dogs current on their Bordetella vaccinations as you never know when they be in an unexpected situation.

How is it Treated?

Although most cases will go away on their own, we like to think we can hasten recovery with antibiotics to directly kill the Bordetella organism. Alternatively, kennel cough may be treated with cough suppressants to provide comfort during natural recovery. Or antibiotics and cough suppressants can be combined.

When is it a Serious Condition?

In very young puppies, especially those with a recent shipping history (i.e., pet store puppies) are especially prone to severe cases of infectious tracheobronchitis (frequently progressing to pneumonia).

In dogs where the distemper virus is involved (usually shelter or pet store puppies), there is tremendous potential for serious consequences.

Vaccination Options

There are basically two options for Kennel cough vaccination: injectable and intranasal.

Injectable is a good choice for aggressive dogs, who may bite if their muzzle is approached. It provides good systemic immunity as long as two doses are given after age 4 months (with an annual booster). Injectable vaccination may only lead to less severe infection and not complete prevention.

Intranasal vaccination may be given as early as 2 weeks of age and immunity generally lasts 10 to 12 months. (Usually this vaccine is boosted annually.) The advantage here is that the local immunity is stimulated, right at the site where the natural infection would be trying to take hold.

It takes 4 days to generate a solid immune response after intranasal vaccination so it is best if vaccination is given at least 4 days prior to the exposure. Some dogs will have some sneezing or nasal discharge in the week following intranasal vaccination. As a general rule, nasal vaccination provides faster immunity than injectable vaccination.

Parainfluenza, Adenovirus type 2, and canine distemper, all members of the Kennel Cough complex, are all covered by the standard DHLPP vaccine, the basic vaccine for dogs. Adenovirus Type 2 serum also immunizes against Adenovirus Type 1, the agent of infectious canine hepatitis.

VACCINATION IS NOT USEFUL IN A DOG ALREADY INCUBATING KENNEL COUGH

What if it Doesn't Improve?

As previously noted, this infection is generally self-limiting. It should be at least improved partially after one week of treatment. If no improvement has been observed in this time, a re-check exam (possibly including radiographs of the chest) would be a good idea.

Tracheal Collapse

What Animals Are Affected?

The victim is almost always a toy breed dog, especially poodles, Yorkshire terriers, and Pomeranians. The disease usually becomes problematic in middle age but can occur at any age. The cartilage defect that leads to the flattened C rings seems to be hereditary.

Many dogs with collapsed tracheas do not ever show symptoms, however, until a second problem complicates things. Factors that bring out symptoms might include:

  • Obesity
  • Anesthesia involving the placement of an endotracheal tube
  • Development of kennel cough or other respiratory infection
  • Increased respiratory irritants in the air (cigarette smoke, dust, etc.)
  • Heart enlargement (the heart can get so big that it presses on the trachea)

If a secondary factor such as one of those listed above should occur and make a previously incidental collapsed trachea a problem, often removal of the secondary factor (weight loss program, getting an air filter, etc.) may clear up the symptoms of the collapsed trachea.

Treatment

The following steps are often helpful in long-term management of the tracheal collapse patient:

  • If any of the above listed secondary problems are of concern, they must be addressed. This may mean that the owner gives up cigarettes or that the dog goes on a formal weight loss program or other treatment to resolve the exacerbating problem.
  • Dogs with collapsed tracheas become unable to efficiently clear infectious organisms from their lower respiratory tracts. Antibiotics may be needed to clear up infection.
  • Cough suppressants such as hydrocodone or torbutrol may be handy.
  • Corticosteroids such as prednisone and related hormones cut secretion of mucus effectively but are best used on a short term basis only due to side-effects potential. Long-term use may promote infection and weaken cartilage further.
  • Airway dilators such as theophylline or terbutaline are controversial as they may dilate lower airways but not the actual trachea. By dilating lower airways, however, the pressure in the chest during inhalation is not as great and the trachea may not collapse as greatly.

In a recent retrospective study of 100 dogs with collapsing trachea, 71% responded to medication and management of secondary factors (obesity, irritants in the air, etc.), 7% had disease so severe that they died within one month of diagnosis, 6% had severe additional disease problems, and the other 16% were felt to be candidates for surgical treatment.

Emergency

The patient's distress can reach a level so severe that the normally pink mucous membranes become bluish and collapse can result. When this occurs, tranquilization is helpful to relieve the anxiety that perpetuates the heavy breathing and coughing. Oxygen therapy and cough suppressants also help. If the patient reaches the point where distress seems extreme or if collapse results, treat this an emergency and rush the pet to emergency veterinary care.

Surgery?

If medical management does not produce satisfactory results, it is possible that surgery may be of benefit. Basically, a rigid prosthesis is placed and bonded around the trachea effectively creating a non-collapsible tube. This is largely effective as long as the portion of trachea that is collapsed is external to the chest. Should the intrathoracic trachea be involved, the surgery becomes far less successful, more expensive, and the prosthesis must be ordered according to the specific patient's measurements.

In all surgery cases, the younger the patient, the more successful the surgery is likely to be with success dropping off in patients over age 6 years. Severity of the collapse prior to surgery is not a tremendous factor in obtaining a successful outcome; improvement is reported in 75% to 85% of patients.

A new technique is being explored using a self-expanding stainless steel prosthesis. A study reporting results of 24 dogs receiving this treatment was published in January 2004. Of these dogs, 96% showed improvement after surgery. Two dogs died within the first week due to stent placement complications. One dog experienced some bleeding. After this 30% were reported to be completely free of symptoms, 61% showed marked improvement, and 4% continued to have symptoms. This appears to be a promising technique but has still only been used in a small number of patients.

Surgical therapy of tracheal collapse requires a surgery specialist. If one is not on staff or cannot be scheduled, referral can be arranged.

Dr. Gordon

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