BOAS in Pugs, Bulldogs and Shih Tzus in India: Grading, Heat, Surgery and What Breeders Should Show You

Signs of Brachycephalic obstructive airway syndrome in dogs

The 9 signs to watch for are listed below. Any one of them is a reason to consult your nearby vet; none of them is a diagnosis.

• Snoring or snorting at rest, loud enough to hear from the next room
• Breathing noise that gets louder after two minutes of gentle walking
• Stopping, sitting or lying down part-way through a walk the dog used to finish
• Switching from nose breathing to open-mouth breathing during mild excitement or gentle play
• Sleeping propped up, sitting, or with a toy held in the mouth
• Gagging, retching or bringing up froth, food or phlegm after eating or exercise
• Nostrils that pinch shut on the inward breath instead of flaring open
• Taking minutes rather than seconds to settle after a short walk
• Struggling on a warm day well before the other dogs in the house do

Breeds on this site that document this condition

Each breed page below carries the figure for this condition with its denominator and its source. The 10 breeds listed are the ones on this site that document it, not a ranking of risk.

What BOAS is, and which dogs are born with it

Brachycephalic obstructive airway syndrome is a breathing obstruction built into the shape of the skull, not an infection the dog caught. The soft tissue inside the nose and throat is sized for a longer skull than the dog has, so the same volume of tissue is packed into a smaller space and the airway narrows. Online Mendelian Inheritance in Animals files it as OMIA:000145-9615 in Canis lupus familiaris.

Brachycephalic means short-headed. Cambridge's own list of brachycephalic breeds names the French bulldog, bulldog, pug, pekingese, shih tzu, Japanese chin, boxer and Boston terrier, and its summary is blunt: breeding selection for extreme brachycephalic features in recent decades has produced dogs predisposed to upper airway obstruction and respiratory distress. Indian sellers describe the same set of dogs as punch faced, and the Indian page that ranks on this topic names the Pug, French Bulldog, English Bulldog, Shih Tzu, Lhasa Apso, Boxer and Boston Terrier Mr n Mrs Pet, Most popular Brachycephalic.

The syndrome is a stack of separate lesions rather than one fault, and an individual dog may have some or all of them. Only the first of them is visible without anaesthesia, which is why an owner can look at a dog every day for five years and never see the problem.

Read that table as a sequence rather than a menu. Over time the condition worsens as a result of the dog working harder to breathe, and tissues in the throat become swollen or inflamed, further obstructing the flow of air. The increased effort generates greater negative pressure inside the airway, which is what produces the secondary lesions such as tonsillar or laryngeal saccule eversion. A dog that has been snoring for three years is not a dog with a stable problem.

The measurement that turns a look into a number

Craniofacial ratio is muzzle length divided by circumferential cranial length, and it is the number the research uses in place of the word flat. Ratios below 0.3 are considered extremely brachycephalic and ratios between 0.3 and 0.5 moderately brachycephalic. The scale of the change is easier to see in the cephalic index, skull width divided by skull length: wolves sit at about 50, the dolichocephalic Doberman Pinscher at about 44, and the Pug has been measured as high as about 99.

Four of the fourteen breeds Cambridge graded in 2026 average a craniofacial ratio below 0.1, meaning the muzzle is under a tenth of the cranial length, and they are the King Charles Spaniel, Japanese Chin, Pekingese and Griffon Bruxellois. For comparison, the Boston Terrier's Grade 0 dogs averaged 0.15 and the Pomeranian's 0.33.

The other short-faced animals in an Indian flat

Cats carry the same conformation and International Cat Care describes the Persian's flattened face as producing narrowed nostrils, a distorted nasal chamber, breathing difficulty, tear overflow from blocked drainage, and an increased need for caesarean birth. The Persian and the Exotic Shorthair are the two brachycephalic cats Indian buyers meet most often, and no cat equivalent of the dog grading scheme exists.

One more short-faced problem travels in the same small city dog and is not the same disease. Across 898 dogs of fourteen brachycephalic breeds, few Affenpinschers were BOAS affected, yet 26 percent of them showed signs of tracheal collapse with a characteristic honking cough. A narrow windpipe and a collapsing windpipe are separate problems with separate treatments, and tracheal collapse in dogs covers the second one.

How common BOAS is, breed by breed, with the denominator

To read a BOAS prevalence figure you first have to know which of two things it counts, because Cambridge publishes both and they differ roughly five-fold for the same breed Tomlinson F, Liu N-C, Sargan DR. One counts dogs a vet would treat. The other counts dogs with no detectable airway noise at all.

The grading scheme runs 0 to 3. Grade 0 dogs are asymptomatic and BOAS free, and Grade 1 dogs show mild respiratory noise with exercise tolerance unaffected; both are counted as clinically unaffected Orthopedic Foundation for Animals. Grade 2 is moderate BOAS, where the dog requires medical attention such as weight control or surgical intervention, and Grade 3 is severe BOAS, where the dog requires immediate surgical intervention; both are counted as clinically affected, or BOAS positive.

So 51.2 percent of Bulldogs are BOAS positive and 10.9 percent of Bulldogs are Grade 0 are both true statements about the same breed, published by the same research group, and they are not in conflict. The gap between them is Grade 1, the dogs whose noise a stethoscope finds and an owner does not. Any page quoting one of those numbers without saying which it is has handed you a figure you cannot use.

The 2026 study extended the same assessment to fourteen more breeds. Cambridge recruited 898 dogs between September 2021 and April 2024 from the pet, breeding and showing population, all over 12 months old, excluding any dog the owner reported had already had BOAS surgery, and sorted the breeds into three risk bands.

Two breeds came out worse than the Pug's reputation suggests. Only 10.9 percent of the Pekingese and 17.4 percent of the Japanese Chin were Grade 0, the two highest BOAS rates in the study. Almost every breed had some detectable level of breathing abnormality, and only the Maltese and Pomeranian had no dogs with clinically significant disease.

The comparison figures everyone quotes for the three famous breeds are not from that study. Tomlinson's team compared each breed against Pugs at 7 percent, French Bulldogs at 10 percent and Bulldogs at 10.9 percent Grade 0, taken from the 2016 plethysmography paper that validated the grading scheme on 266 brachycephalic dogs, 100 pugs, 100 French bulldogs and 66 bulldogs, plus 28 non-brachycephalic controls. Quoting 7 percent for Pugs without that provenance attaches a 2016 cohort's number to a 2026 headline.

The most useful result in the paper is the one that breaks the pattern. The King Charles Spaniel has a mean craniofacial ratio of 0.05, among the flattest faces measured anywhere, and 40 percent of them graded clean. Conformation sets the odds for a breed. It does not decide the individual dog in front of you.

What a vet actually diagnoses, which is a third number

Primary-care records give a much lower rate than research grading does, because the dog has to be brought in first. Of 905,544 dogs under UK primary veterinary care in 2016, a sample of 4,308 Pugs against 21,835 non-Pugs gave Pugs 53.92 times the adjusted odds of a BOAS diagnosis, 95 percent CI 36.22 to 80.28, and 51.25 times the odds of stenotic nares, 95 percent CI 24.93 to 105.37. A sample of 2,781 French Bulldogs against 21,850 other dogs from the same population gave 42.14 times the odds of stenotic nares, 95 percent CI 18.50 to 95.99, and 30.89 times the odds of BOAS, 95 percent CI 20.91 to 45.64.

Those are enormous ratios against a small base rate, and the base rate is small because the diagnosis depends on somebody noticing. An estimated 60 percent of owners do not recognise the clinical signs of BOAS, a figure Liu's team carry from two earlier papers rather than measure themselves, and they note that the true prevalence may therefore be much higher.

An earlier English study measured the gap directly. At least one upper respiratory tract disorder was recorded in 22.0 percent of extreme brachycephalic dogs, 95 percent CI 18.0 to 26.0, against 9.7 percent of moderate and non-brachycephalic dogs, 95 percent CI 7.1 to 12.3, with Pugs at 26.5 percent, French Bulldogs at 20.0 percent, Bulldogs at 19.5 percent, Yorkshire Terriers at 13.0 percent, Border Terriers at 9.0 percent and West Highland White Terriers at 7.0 percent. Adjusted, the extreme brachycephalic group carried 3.5 times the odds, 95 percent CI 2.4 to 5.0.

The same study followed the dogs to the end. Extreme brachycephalic dogs died at a median of 8.6 years against 12.7 years for the moderate and non-brachycephalic group, and 4 of 24 deaths in the extreme group, 16.7 percent, were associated with upper respiratory tract disorders, against 0 of 59 deaths, 0.0 percent, in the comparison group.

The signs owners are trained to call normal

Owners are trained by the breed itself to hear snoring, snorting and a loud sleep as character, and an estimated 60 percent of them do not recognise the clinical signs of BOAS. The scanning list above is what a vet grades. This section is what each item on it means.

Noisy breathing is the most recognisable sign of BOAS, and it can also impair a dog's ability to exercise, sleep and cope with heat or stress. Assessors listen for three distinct noises and the names matter because they point at different parts of the airway. Stertor is a low pitched vibrational noise heard above the level of the larynx, stridor is a higher pitched sawing noise heard over the larynx, and nasal stertor is a low pitched nasal snort or vibration. Stridor is the one that suggests laryngeal collapse, which is the secondary lesion that turns a treatable airway into a guarded one.

Exercise intolerance is the sign that separates a Grade 1 dog from a Grade 2 dog, and it is the one owners explain away as laziness. The formal exercise tolerance test is deliberately modest, three minutes at a fast trot, because the point is to catch a dog that cannot manage an ordinary walk rather than to find the limit of a fit one. A dog that used to finish the evening round and now stops at the gate has changed grade, whatever the calendar says.

A grade is built from three categories, respiratory noise, inspiratory effort, and dyspnoea, cyanosis or syncope, and the highest grade from any one of them becomes the final grade. A dog can therefore be quiet at rest and still be Grade 3, because one episode of blue gums outranks a peaceful morning.

The signs that are not about breathing at all

Gut signs travel with airway signs closely enough that a clinical review calls BOAS much more than a surgical problem. The prevalence of gastrointestinal disease in brachycephalic dogs presenting for respiratory signs is as high as 97 percent, and the most common clinical signs are regurgitation, vomiting and dysphagia. Lip smacking, drooling, extending the head and neck while swallowing, retching, grass eating, surface licking and nocturnal restlessness all belong to the same picture, and affected dogs frequently bring up frothy sputum during exercise or excitement.

Sleep is the second place the disease hides. Abnormal sleep behaviour includes sleeping with an open mouth in sitting or elevated positions, sleep fragmentation, sleep apnoea, sleep arousal, or complete inability to sleep with consequent daytime sleepiness, and owners often do not perceive sleeping problems as restrictive for their dog's welfare compared with exercise intolerance. A dog that props its chin on a step to sleep is managing its own airway.

Below both of those sits a change nobody can hear. Bronchial abnormalities occur in over 85 percent of dogs with BOAS, and many brachycephalic dogs that appear clinically normal are in fact suffering from chronic hypoxia and its systemic consequences, with concurrent reflux-associated conditions, sleep disorders and systemic hypertension.

The two-minute test you can run in your own corridor

Walk the dog briskly for three minutes and listen before and after, because that is exactly what the official assessment does. The scheme's exercise test keeps the dog moving for three minutes at a brisk trot of roughly 4 to 5 miles per hour, and the assessor auscultates immediately afterwards to compare against the resting baseline. You will not produce a grade at home. You will find out whether your dog gets louder, and that is the observation a vet needs from you.

Record it. A ten-second phone video of the dog breathing after a walk, taken in April and again in October, gives a vet something an owner's memory cannot, and it costs nothing.

The Respiratory Function Grading Scheme, and what it can tell an Indian buyer

Grading a dog's airway takes a 15-minute, completely non-invasive appointment with a trained veterinary surgeon, who listens to the breathing at rest, walks the dog briskly for three minutes, listens again and assigns a grade from 0 to 3 Orthopedic Foundation for Animals. The Royal Kennel Club and the University of Cambridge run it, and it is licensed to 18 countries and territories. India is not among them.

The exam runs in four steps. A short health survey about the dog's breathing history comes first, then a brief physical examination while the dog is calm, including auscultation with a stethoscope positioned gently on the side of the neck to establish a baseline, then a brief exercise test consisting of a brisk three-minute walk at roughly 4 to 5 miles per hour, and finally a post-exercise auscultation to compare against the baseline. The exercise test is designed to expose clinical signs in an otherwise calm and asymptomatic dog, and it is explicitly not a test of cardiovascular fitness.

Timing is fixed. The minimum age for testing is 12 months, exams on dogs under 12 months are considered preliminary and are ineligible for certification, and dogs are reassessed every two years for their lifetime or until they stop being used for breeding. A grade is a snapshot with an expiry date, not a permanent property of the dog. Age was positively associated with BOAS across all 898 dogs Cambridge graded in 2026, at an odds ratio of 1.08 per year, 95 percent CI 1.01 to 1.16, p = 0.02.

Seventeen breeds, and a disagreement on the scheme's own pages

The UK scheme lists 17 eligible breeds: Affenpinscher, Boston Terrier, Boxer, Bulldog, Cavalier King Charles Spaniel, Chihuahua, Dogue de Bordeaux, French Bulldog, Griffon Bruxellois, Japanese Chin, King Charles Spaniel, Maltese, Pekingese, Pomeranian, Pug, Shih Tzu and Staffordshire Bull Terrier. The Orthopedic Foundation for Animals, which holds the North American licence, posted an April 2026 update adding 13 breeds to the list eligible for exams and official certification on the strength of the Cambridge fourteen-breed study.

Read further down the same OFA page and it still says something different. Under its own heading on breed eligibility it reads that the screening program is currently open to Pugs, Bulldogs and French Bulldogs, and that other brachycephalic breeds can participate in the exams but are ineligible at this time for certification. Both statements sit on one page, read on 27 September 2026. Bonbeno prints both rather than picking, and the practical consequence for a buyer is simple: confirm certification eligibility for your breed with the examiner before you pay.

Why a published grade is not a random sample

Grades 0 and I are released by default and posted on the OFA website, while Grade II and III results are only released if the owner authorises release. That single rule shapes everything a buyer sees. A breeder showing you one certificate is showing you a result somebody chose to publish, and the register a buyer browses is skewed towards good grades by construction rather than by breeding.

The appeal rules tighten it further. An appeal against a grade must be lodged in writing with the Royal Kennel Club within 30 days of the examination, a dog cannot be reassessed within six months of an assessment unless an appeal is lodged, and any assessment done inside six months without following the appeal process is deemed invalid and withdrawn from publication. Those exist precisely because a bad grade is worth money to make disappear.

The line in the protocol that matters most in India

The protocol requires a cool room. In the OFA's general exam guidelines, the exams and the exercise test must be done in a climate controlled environment where the dog is not subject to additional stress from heat, and the ambient temperature should be recorded as part of the exam. Read that as an Indian owner and two things follow. Running a three-minute trot test on a flat-faced dog in an uncooled Indian clinic in April is a heat exposure, not an assessment, and a grade obtained in a hot room is not comparable to a grade obtained in a cool one.

The fee structure is published and it is not an Indian one. OFA registration costs 15 US dollars and is required for all exam participants, while the veterinary exam itself is priced separately and set by the examining veterinarian. In the UK, each assessor sets their own fee and that fee includes a 5 pound admin fee for the Royal Kennel Club. Neither figure converts into a price an Indian owner can pay, because neither scheme operates here.

One country has made the grade a condition of competing. All eligible Bulldogs, French Bulldogs and Pugs exceeding 14 calendar months on the first day of Crufts 2026 must have a valid Respiratory Function Grading Scheme assessment to attend, the requirement is mandatory for entry into the show rather than for individual classes, and all dogs assessed as Grade 2 or 3 are excluded and not permitted to enter or attend. That is what a registry using its own leverage looks like.

The four things worth asking an Indian breeder are listed below.

1. Ask for a grade for both parents, and accept that in India you will usually be told there is none, because the scheme is not licensed here.
2. Ask what the grades were, not whether the dogs were tested, since Grade 2 and Grade 3 results are published only when an owner authorises it.
3. Ask for a straight-on nostril photograph of the sire, the dam and the puppy, taken in daylight, because nostril stenosis is the one major risk factor visible without equipment.
4. Ask what happened after a three-minute walk, which is the same question the official exercise test asks.

How a vet confirms BOAS, and what else the workup finds

A vet confirms brachycephalic obstructive airway syndrome from a combination of the breed, the clinical signs and the physical examination findings, and most dogs are diagnosed between one and four years of age with males and females affected equally. The grade tells you how bad it is. Staging the lesions tells a surgeon what to do.

Stenotic nares can be observed through a routine examination, and that is where the free part of the diagnosis ends. Further evaluation requires the dog to be lightly anaesthetised so the soft palate and laryngeal saccules can be assessed, the diameter of the trachea is measured from x-rays of the neck and chest, and advanced testing can include endoscopy or a CT scan of the upper airway.

That sequence contains an uncomfortable loop. The examination that stages the airway needs an anaesthetic, and severely affected dogs are at a higher anaesthetic risk, while dogs that have developed secondary lesions such as Grade II to III laryngeal collapse carry a prognosis that may be guarded. The dogs who most need the information are the dogs for whom getting it costs the most.

The objective test, and why it was built

Whole-body barometric plethysmography measures the airway without touching it. The dog stands inside a transparent chamber with a constant ventilating airflow, the chamber monitors the pressure changes caused by the dog breathing in and out, no sedative or general anaesthesia is given, and the test takes about 30 minutes. Cambridge reports over 1800 brachycephalic dogs tested with a tolerance rate of approximately 85 percent, and derives a BOAS Index on a scale of 0 to 100 percent, where a higher index means more severe disease, which lets the team monitor progression and evaluate surgical outcomes.

The validation study is the reason the grading scheme can be trusted at all. In 266 brachycephalic dogs, 100 pugs, 100 French bulldogs and 66 bulldogs, against 28 non-brachycephalic dogs, the BOAS index predicted BOAS status for each breed with 94 to 97 percent accuracy, 95 percent CI 88.9 to 100 percent, measured as area under the ROC curve. Obesity, at p = 0.04, and stenotic nares, at p = 0.004, were both significantly associated with BOAS in the same study.

The finding inside it that should change how an owner thinks is about the dogs who look fine. Minute volume was significantly decreased in asymptomatic pugs at p = 0.009, French bulldogs at p = 0.026 and bulldogs at p below 0.0001 when compared with non-brachycephalic controls. A quiet flat-faced dog is not moving the same volume of air as a dog with a muzzle, and the machine can see that when a stethoscope cannot.

What else the workup turns up while it is in there

A vet who asks about vomiting when you came in about snoring is following the evidence. Respiratory restriction in bulldog breeds, pugs and Boston terriers frequently coexists with pathologies of the gastrointestinal tract, and the review that made the point is titled around it.

Owners underweight this list because the signs look like separate small problems. Lip smacking after food, a dog that brings up froth on a walk, a dog that cannot settle at night, and a dog that snores are one disease presenting four ways. Bring all four to the appointment, because the vet in front of you will only see the one you mention.

What treatment does, and what it does not do

Treatment for brachycephalic obstructive airway syndrome widens what can be widened, shortens what can be shortened and manages the rest for life, and the literature is explicit that it is not a cure: in many cases a fully successful outcome is unachievable. Surgery buys airway. It does not buy a different skull.

Mild cases are treated conservatively, and every item on that list is free. Cornell's conservative plan is maintenance of a healthy weight, minimising panting, avoidance of excessive heat and humidity, controlled activity, minimising stress, and using a harness instead of a neck collar. More severe cases require surgical correction, and earlier intervention leads to better outcomes.

The last row is the one that decides some cases. A dog whose windpipe is proportionally too narrow keeps that windpipe after the best nostril and palate surgery available, which is why the pre-surgical x-ray of the neck and chest is not a formality.

What the outcome numbers actually say

The largest published series is encouraging and specific. Across 423 dogs treated with ala-vestibuloplasty and H-pharyngoplasty using a CO2 laser between 2011 and 2017, the overall mortality rate was 2.6 percent, major complications were respiratory distress in 2.1 percent, heatstroke in 0.5 percent and bronchopneumonia in 0.5 percent, and no dogs required revision surgery. Median follow-up ran 36 months with a range of 12 to 91 months, and 341 owners, 80.6 percent, completed the long-term questionnaire.

Read the improvement figures as two separate numbers. Improvement in signs associated with the respiratory system was reported in 72 percent of the dogs, improvement in digestive signs in 34 percent, and owner satisfaction was 97.1 percent. Owners were far happier than the digestive results were good, which is worth knowing before you read a testimonial.

A second series measured the short-term cost. Among 258 dogs having BOAS surgery at a UK referral hospital between 2013 and 2017, the proportion regurgitating rose from 28 dogs, 10.9 percent, while hospitalised before surgery to 89 dogs, 34.5 percent, during the first 24 hours afterwards, and younger dogs and dogs with a history of regurgitation were predisposed. The authors' own conclusion is that this justifies counselling owners about the complication in advance, so ask about it.

The objective measurement is the most sobering of the three. In 50 client-owned pugs, French bulldogs and bulldogs assessed by plethysmography before and after upper airway corrective surgery, the median BOAS index fell from 76 percent to 63 percent. That is a real improvement in a real airway, and it is not a normal airway. Negative prognostic factors in the same study were younger age, normal body condition, the presence of laryngeal collapse, and treatment with the traditional multilevel surgery rather than the modified one.

A third source takes a third position, and it is the one most owners will actually read. VCA's client page states that the earlier abnormalities are corrected the better the outcome, since the condition worsens over time, that early correction of stenotic nares or an elongated soft palate will significantly improve airway function and may prevent the development of everted laryngeal saccules, and that dogs under two years of age at the time of surgical correction have a better post-operative prognosis than older dogs. Two of the three sources therefore favour operating sooner and one does not, which is a disagreement to take to your surgeon rather than a settled answer.

The first hours after surgery are the ones to plan for. In the early post-operative period the surgical sites may swell and interfere with breathing, so the veterinarian monitors the patient closely, and the degree of monitoring depends on which procedures were performed. An overweight dog arrives at that moment with less reserve than a lean one, which is why weight loss is described as equally important regardless of the surgery.

The half of treatment that is not surgery

Medical management of the gut changes the surgical result. Treating the digestive tract is frequently employed because it decreases the risk of postsurgical complications and substantially improves the prognosis and long-term outcome in over 70 percent of brachycephalic dogs. Weight loss, exercise restriction and environmental modification are described as equally important regardless of what medical and surgical treatment the dog receives.

This page names drug classes and never a dose. Reflux and regurgitation are managed with proton pump inhibitors, prokinetics and feeding management, inflammation in a crisis with corticosteroids, and hypertension with calcium channel blockers or renin-angiotensin drugs. The amount, the drug and the duration are decisions your veterinarian makes for the animal in front of them, after examining it.

One ceiling is worth stating plainly, because owners are sold past it. Studies using plethysmography suggest that both dogs with BOAS and dogs that have undergone corrective surgery remain affected by the systemic consequences of the disease. There is no cure for a skull shape, and the review says so in its own terms when it records that a fully successful outcome is unachievable in many cases.

What BOAS surgery costs, and why the page that ranks in India prices it in pounds

No Indian clinic, hospital chain or government rate card that this page could open publishes a price for BOAS airway surgery, so what follows is the surgical band India does publish and the British figure that currently ranks for the Indian query Streatham Hill Vets, London.

Search the Indian cost query and a London practice answers it. Streatham Hill Vets puts the typical BOAS surgery cost in the UK at approximately 2,000 to 6,000 pounds and breaks that into three tiers: 2,000 to 3,000 pounds for a younger healthy dog needing one or two straightforward procedures such as nostril widening at a general practice, 3,000 to 4,500 pounds for a multi-procedure surgery at an experienced practice with dedicated surgical facilities, and 4,500 to 6,000 pounds or more for a complex case or a specialist referral centre in a major city. That is a real price list. It is not an Indian one, and nothing on the page converts it.

Three Indian government veterinary hospitals publish rate cards that a brachycephalic dog would actually be billed against. None of them names the operation.

Every figure in that table is a rupee price published by the institution itself. Divided by 84.38 the range runs from 0.36 to 35.55 US dollars and divided by 74 from 0.41 to 40.54, and not one of them lands on a round dollar value, so these are Indian rate cards rather than a converted dollar list.

What is absent from all three is the same thing. Not one of them carries a line for stenotic nares, nostril widening, alaplasty, soft palate resection, staphylectomy or laryngeal saccule removal, and the word brachycephalic appears nowhere on any of the three pages Tamil Nadu Veterinary and Animal Sciences… Bihar Animal Sciences University, Patna. BASU's card has no anaesthesia line at all. Read them as the band the bill will sit in, not as a quote.

Notice where those three rate cards are. ICAR-IVRI sits at Izatnagar in Uttar Pradesh, BASU at Patna in Bihar, and TANUVAS at Chennai and Namakkal in Tamil Nadu Bihar Animal Sciences University, Patna Tamil Nadu Veterinary and Animal Sciences… Tamil Nadu Veterinary and Animal Sciences…. Searches for a published veterinary surgery tariff naming an airway procedure in Mumbai, Delhi, Bengaluru, Hyderabad or Kolkata returned nothing this page could open, so an owner in Maharashtra, Karnataka or West Bengal has no published figure to plan against at all. The government teaching hospitals are the only Indian institutions printing a number, and they are not where most flat-faced dogs live.

One more caution about Indian rate cards. TANUVAS states that its fee structures are uniform across the hospitals under its Directorate of Clinics, and then publishes Rs 1,500 for major small-animal surgery at Madras Veterinary College against Rs 500 at its Madhavaram peripheral hospital. Ask the hospital you are actually going to.

India does do this surgery, and one Indian series proves it

The operation is performed in India at a government teaching hospital, and it has been written up once. A 2021 paper in the International Journal of Current Microbiology and Applied Sciences reports the histopathology of the soft palate in 12 pugs presented with brachycephalic syndrome to the Madras Veterinary College teaching hospital in Chennai, all of which had a complete clinical examination of the upper airway including radiography and computed tomography under general anaesthesia, with soft palate samples collected after surgical resection using a carbon dioxide laser and conventional techniques.

Its finding is worth carrying on its own. The increased thickness of the soft palate in those dogs was not due to muscle hypertrophy or fat deposition, but to significantly increased stroma within the lamina propria, oedema and an increased proportion of salivary tissue, with extensive degenerative lesions in the palatine musculature from persistent traumatic injury, a condition the authors say is rarely seen in normocephalic dogs. The authors also state the gap themselves, writing that studies on the histopathology of the elongated soft palate are few and that to the best of their knowledge there are no publications in this country to date.

That paper shares two authors with the Madras Veterinary College clinics faculty whose rate card sits in the table above Prakash Kumar B, Mala Shammi, Ramani C. The surgery, the CT scanner and the rate card are in the same building.

The insurance answer is different in India, and it is written down

Ask a British page whether insurance covers BOAS surgery and the answer is usually yes with caveats about pre-existing conditions and breed-inherent issues. Ask the Indian wordings and one of them answers by name. Go Digit's general exclusion 30 reads that Brachycephalic syndrome / Brachycephalic airway obstructive syndrome and related problems such as elongated soft palate, stenotic nares, hypoplastic trachea, and everted laryngeal saccules are not covered, and adds that any consequential problems related to these conditions and nasal fold resection or surgery will also not be covered.

That single clause removes every line of this page's treatment section from cover in one sentence, and it names the lesions individually so that nothing is left to argue about. The full comparison of what the five Indian pet policies cover and exclude sits in pet insurance in India. Read your own wording before you buy a flat-faced puppy, not after.

Why an Indian summer is the part that decides

Heat is the multiplier on a flat face, because panting is a dog's cooling system and BOAS is a disease of the airway that panting has to run through. Across 905,543 UK dogs, brachycephalic dogs carried 2.10 times the odds of heat-related illness compared with mesocephalic dogs, 95 percent CI 1.68 to 2.64, p below 0.001.

Five of the nine breeds with significantly increased odds of heat-related illness in that study were brachycephalic, the Bulldog, French Bulldog, Dogue de Bordeaux, Cavalier King Charles Spaniel and Pug, and the Boxer trended towards increased odds at 2.26, 95 percent CI 0.95 to 5.34. Purebred dogs carried 1.86 times the odds of crossbreds, 95 percent CI 1.39 to 2.49, and dogs over 50 kg carried 3.42 times the odds of dogs under 10 kg, 95 percent CI 1.54 to 7.57.

The result that should change how an Indian owner reads 2.10

Three of the flattest small breeds came out at the bottom of the same table, not the top. Of the breeds analysed, the Lhasa Apso, Shih tzu and Chihuahua had the lowest odds of heat-related illness despite all being brachycephalic breeds, and the authors attribute it to bodyweight, since all three typically weigh under 10 kg and smaller dogs lose heat faster. The model gives the Shih-tzu 0.47, 95 percent CI 0.18 to 1.24, p = 0.127, the Chihuahua 0.44, 95 percent CI 0.17 to 1.18, p = 0.102, and the Lhasa Apso 0.24, 95 percent CI 0.03 to 1.76, p = 0.159.

None of those three reached statistical significance, so this is a direction rather than a proof, and a wide confidence interval on a small number of events is exactly what it looks like. It still matters here, because the Shih Tzu and the Lhasa Apso are two of the seven brachycephalic breeds the Indian market sells hardest. A blanket 2.10 read across every flat face gets the small ones wrong in one direction and the Bulldog wrong in the other.

The finding that fits India best is about mixed dogs. Brachycephalic crosses had the lowest incidence of heat-related illness across all skull types in that study, including the unrecorded group, though they did not reach a significantly reduced odds ratio at multivariable level at 0.22, 95 percent CI 0.03 to 1.56. India's dog population is overwhelmingly mixed. A Pug cross is measurably not a Pug, and the Indian Pariah Dog is not in this conversation at all.

The hottest month is not always the hardest one. Panting works by moving air across the nasal turbinates to evaporate moisture, so a shortened face reduces the surface area available for evaporative cooling, which is the mechanism behind the reduced heat dissipation of brachycephalic dogs. Cornell's conservative management plan for BOAS therefore names avoidance of excessive heat and humidity together, not temperature alone. In coastal Indian cities the monsoon months look mild on a thermometer and are the months in which evaporation works least well, which is why a Mumbai or Kolkata owner should judge an August walk by how humid it is rather than by the number on the forecast.

The first-aid protocol, the thresholds five different bodies publish and the India Meteorological Department alert levels are all on heat stroke in dogs, and the hour-by-hour summer routine is in heat safety for dogs in India. This page does not repeat them.

The Indian instruments that do name the flat face

Indian aviation names brachycephalic breeds and Indian railways does not. That is the whole regulatory picture in one sentence, and it is worth knowing before you book anything.

SpiceJet's is the most specific document any Indian carrier publishes on this condition. Its Terms and Conditions state that it will not accept the listed breeds of dogs, including snubbed-nose dogs and short-muzzled dog breeds, as these animals are known to be susceptible to increased risk of heat stroke (when exposed to stress or changes in temperature), breathing difficulties or increased travel stress. The named examples include the Chinese Pug and Dutch Pug, English Bulldog and French Bulldog, Boxer, Boston Terrier, Bull Terrier, Staffordshire Bull Terrier, English Toy Spaniel, Tibetan Spaniel, Brussels Griffin, Chow Chow, Japanese Chin, Lhasa Apso, Pekingese, Shar Pei and Shih Tzu. An Indian airline has, in effect, published a brachycephalic risk list that Indian breeding regulation has not.

Air India contradicts itself across its own two domains, and both pages returned HTTP 200 on 27 September 2026. The passenger site says snub-nosed breeds are not permitted in the cargo compartment, full stop. The cargo site says such pets are accepted as cargo when the temperature is below 25 C. Bonbeno prints both rather than picking, and an owner should get the answer in writing from the office actually handling the booking.

IATA sits behind all of it and says less than people assume. Its own guidance states that transport of snub nose dogs, such as boxers, pugs, bulldogs and Pekinese, in hot season is not recommended, because these animals have difficulty in maintaining a normal body temperature in hot weather, and that snub-nosed breeds require a 10 percent larger container. IATA also states plainly that it is the role of governments to set and enforce the rules concerning the transportation of live animals, while IATA publishes the Live Animals Regulations that its members are expected to adhere to. The breed embargo lists are the carriers' own.

The railway rule that has no breed in it

Indian Railways carries a pug and a Labrador under identical rules. A pet dog can be carried in a dog box in the Second Class Luggage and Brake Van, or with the passenger in AC First Class and First Class only when the whole coupe, two-berth or four-berth, is booked for exclusive use, and dogs are not allowed in AC 2 tier, AC 3 tier, AC Chair Car, Sleeper Class or Second Class. A dog in the dog box is charged at luggage rates at 30 kg per pet dog, or 60 kg per dog in AC First and First Class, and in most trains there is one dog box, one dog per train, booked at the counter one hour before departure with no advance booking.

Southern Railway prices the same journey at six times the Scale-L luggage rate subject to a minimum of Rs 30, and requires a veterinary fitness certificate obtained 24 to 48 hours before the journey stating the dog is not suffering from any infectious or contagious disease, submitted with the vaccination card at booking. The same notice requires that the dog be properly chained with a mouth guard before it is boarded into the brake van and kept inside the dog box.

Six railway pages were searched for brachycephalic, snub, flat-faced, pug and bulldog, and the words appear in none of them. The only place breed appears at all is on Eastern Railway's booking page, where a doctor's certificate clearly mentioning the breed, colour and gender of the pet dog is required, which makes breed an identification field rather than a restriction.

What India has not published

There is no Indian prevalence figure for BOAS. A Europe PMC search for brachycephalic, BOAS or stenotic nares with dog, dogs or canine and India, all in the title or abstract, returned zero records on 27 September 2026, while three controls run in the same session on the same instrument returned 852 records for the same query without India, 13 for Labrador Retriever with an Indian affiliation, and 2,203 for canine or dog with an Indian affiliation. NCBI's own E-utilities esearch returned HTTP 500 on every attempt that day, including on the trivial control term dog, which is why Europe PMC was used instead.

Two Indian records exist and neither is a prevalence study. The Chennai series of 12 pugs described above is the only Indian clinical BOAS study this page located. The only PubMed-indexed brachycephalic airway paper with an Indian affiliation is a 2026 deep-learning method for classifying stenotic nares from nostril photographs, from Netaji Subhas University of Technology in New Delhi, which reports 96.50 percent accuracy for its best model and never states the country the dogs were in, so it is an Indian institution rather than a verified Indian cohort. Its own framing is the useful part, that stenotic nares are recognised as a major conformational risk factor associated with BOAS, but their presence alone does not establish a clinical diagnosis, which requires comprehensive history and physical examination.

What to check before you buy a flat-faced puppy in India

Grade the nostrils yourself, because nostril stenosis is the one major BOAS risk factor visible without equipment and it separates the risk far more sharply than muzzle length does. Among 604 Cambridge dogs, 25 percent of those with open or mildly stenotic nostrils were clinically affected, against 70 percent of those with moderately or severely stenotic nostrils.

The study's own conclusion from that split is the single most useful sentence a buyer can carry. Considering a more effective criterion to assist in breeding away from BOAS, the authors judged that the nostril grading would likely be superior to craniofacial ratio. You do not need a tape measure or a photograph protocol. You need to look into the nose in daylight, and then look again straight after the puppy has played.

The study treated open or mild as acceptable for these breeds and defined moderate or severe as stenotic nostrils. That is a decision rule a buyer can apply in a stranger's front room in thirty seconds, and it is the only one on this page that costs nothing.

The measurement three papers openly disagree about

Craniofacial ratio is the number welfare campaigns quote, and the evidence on it has moved twice in ten years. Bonbeno prints all three positions rather than the most quotable one.

Read together, those three results are not a contradiction so much as a change of scale. Muzzle length decides which breed you are choosing. Nostrils and weight decide which dog inside that breed you are choosing Liu N-C, Troconis EL, Kalmar L, Price DJ Tomlinson F, Liu N-C, Sargan DR.

One number the literature prints two ways

The Bulldog's headline Grade 0 figure is not stable. Cambridge's Boston Terrier paper of 2024 compares its cohort against Bulldogs at 15.2 percent Grade 0, and the same group's fourteen-breed paper of 2026 compares against Bulldogs at 10.9 percent, and both cite the same 2016 plethysmography study as the source Tomlinson F, Liu N-C, Sargan DR Liu N-C, Adams VJ, Kalmar L, Ladlow JF. Both papers give French Bulldogs 10 percent. Bonbeno prints both Bulldog figures and does not pick between them, because the reason for the difference is not stated in either paper.

What Indian regulation requires, and what it leaves unnamed

India's only national dog-breeding rule does require genetic-defect testing and does not mention breathing. Clause 8(10) of the Prevention of Cruelty to Animals (Dog Breeding and Marketing) Rules, 2017 reads that the dogs shall have been tested for genetic defects, including hip dysplasia, progressive retinal atrophy, night blindness, hypothyroidism, entropion, ectropion, overshot, undershot jaw, wry mouth, two or more missing teeth, unilateral cryptorchid or full cryptorchid males.

Eleven defects are named and not one of them is respiratory. The words brachycephalic, respiratory and breathing appear nowhere in the 14-page gazette notification, while hip dysplasia appears in it once. The word including matters, though, because it makes the list illustrative rather than exhaustive, so an airway defect is unnamed rather than excluded. A breeder covered by these rules is required to screen a litter for an undershot jaw and is nowhere told to grade its breathing.

The global veterinary body has taken a position and published it for the people who decide. The World Small Animal Veterinary Association's Hereditary Disease Committee produced its BOAS educational material for veterinarians, breeders, owners, kennel clubs and regulatory agencies, framed around practical science-based solutions, and its own line is that the snuffling and snoring may sound funny but it is not funny for the dogs. The material is published in English, Portuguese, French, Spanish and Russian with Chinese to follow, and in no Indian language, which is a fair measure of where this campaign has and has not reached.

Two client-facing veterinary sources say the same thing about breeding in plainer words than any registry does. Dogs with pronounced breathing difficulty, or that require surgery to correct airway obstruction, should not be used for breeding, and it is usually recommended that they be spayed or neutered at the same time as the surgical correction is performed. The syndrome has been perpetuated by selecting and breeding dogs for cosmetic appearance rather than breathing ability.

Set that beside what a private Indian airline already publishes. SpiceJet lists the Pug, Shih Tzu, Pekingese, Japanese Chin, Lhasa Apso, Boston Terrier, English and French Bulldog and Boxer among breeds it refuses to carry because they are susceptible to increased risk of heat stroke, breathing difficulties or increased travel stress. An airline's cargo desk has written down a brachycephalic risk list that the breeding rules have not.

The five questions worth asking before money changes hands are listed below.

1. Ask both parents' respiratory function grades, accepting that the answer in India is usually none, because the scheme is licensed in 18 countries and not here.
2. Grade the puppy's nostrils front-on in daylight against the four-point scale above, and walk away at moderate or severe.
3. Watch the puppy after two minutes of play, because switching from nasal to oral breathing after very gentle exercise is the severe end of that scale.
4. Ask for the written veterinary health certificate separately from any registration paper, since registration documents parentage and the gazette rule names no respiratory test.
5. Ask what the litter's parents sound like after a three-minute brisk walk, which is the question the official assessment asks.

Living with a flat-faced dog in an Indian city

Two of the three measured risk factors for BOAS are fixed before you bring the dog home, and the third is bodyweight. Across 898 dogs, body condition score, nostril stenosis and craniofacial ratio were the three factors significantly correlated with BOAS, and together they accounted for about 20 percent of the variation in BOAS status.

Weight carries a measurable odds ratio, not a vague warning. Body condition score was positively associated with BOAS at an odds ratio of 1.8, 95 percent CI 1.3 to 2.6, across the whole fourteen-breed population, and within the Shih Tzu specifically it reached an odds ratio of 5.0, 95 percent CI 1.1 to 28.9, p = 0.047. Obesity was also significantly associated with BOAS in the plethysmography validation study, at p = 0.04.

Packer's model puts the same point in a form you can picture. A neutered Pug with the breed average craniofacial ratio of 0.11 and a neck girth of 32 cm had a predicted BOAS risk of 0.93, and adding a single point of body condition score, to 6 out of 9, raised the predicted risk to 0.98. One point of condition on an already-flat dog closes most of the remaining margin.

The neck is the other soft target. Thicker neck girths increased BOAS risk in both of Packer's populations, a risk factor previously recognised in human sleep apnoea and not realised in dogs before that study, and in male Bulldogs a neck girth ratio above 0.71 predicted BOAS at roughly 70 percent sensitivity and specificity. Cornell's conservative management list puts a harness instead of a neck collar alongside weight control, minimising panting, avoiding excessive heat and humidity, controlled activity and minimising stress.

The daily routine that follows from all of that is short.

• Weigh the dog monthly and write it down, because body condition is the one risk factor of the three that you can still change.
• Walk on a Y-front harness, never a neck collar, since neck girth is an independent measured risk.
• Feed from a slow feeder, because regurgitation, vomiting and dysphagia belong to this disease rather than to bad manners.
• Film ten seconds of breathing after a walk each April and each October, so a vet can compare rather than rely on your memory.
• Watch how the dog sleeps, because sleeping propped up, sleep fragmentation and daytime sleepiness are recorded signs owners routinely discount.
• Move both walks out of the sun, because exercise intolerance and heat intolerance are the same restriction met from two directions.

Re-grade, because the dog changes

A grade expires. Dogs should be assessed from 12 months and reassessed every two years for their lifetime, or until they stop being used for breeding, and a Grade 0 dog under two years old is still advised to have an annual health check because BOAS can develop later in life. Age was positively associated with BOAS across all 898 dogs at an odds ratio of 1.08 per year, 95 percent CI 1.01 to 1.16, p = 0.02.

A rehomed adult flat-faced dog is in some ways easier to judge than a puppy for exactly that reason. By three or four years old the airway has declared itself, and what you hear is close to what you will live with. Surrendered brachycephalic dogs turn up in Indian city rescue for ordinary reasons, and an adult whose breathing you can assess today carries less uncertainty than a puppy whose nostrils have not finished narrowing.

What this page cannot decide for you

Nothing here tells you whether your dog needs treatment, and no drug or dose appears anywhere on this page on purpose. A Grade 1 Shih Tzu in a cooled Pune flat and a Grade 1 Shih Tzu on a Nagpur terrace are the same grade and different animals, because the heat exposure is different and heat is where this condition kills. Take the grade, the weight log, the regurgitation history and the ten-second video to a veterinarian who handles brachycephalic cases routinely, and let the person who has examined your dog decide.

The breed pages carry the rest of each animal's picture. Start with the Pug, the French Bulldog, the Bulldog, the Shih Tzu or the Pekingese, and read heat safety for dogs in India before the first 40 C day rather than during it.