Tracheal Collapse in Yorkiepoos

Yorkiepoos, or Yorkie Poo, as they are often called, is the resulting offspring of a Yorkshire Terrier and a Miniature or Toy poodle. The Yorkiepoo is therefore considered a "hybrid" dog. Big in spirit but small in stature, the average Yorkipoo weighs between 5-15lbs., with a height of only 7-15 inches. The average life expectancy of the Yorkipoo is 10-15 years. Yorkiepoo fur is classified as hypo-allergenic.

What Is Tracheal Collapse?

The trachea (or windpipe) is a flexible tube connecting the throat to the lungs. The trachea comprises six C-shaped rings of rigid cartilage that maintain the shape of the trachea and keep the trachea open to allow air to enter the lungs. In a healthy trachea, the two ends of the C (the rings do not completely cover the trachea, only about 83%) are joined by a soft membrane that completes the circle. In tracheal collapse, the cartilage rings lose their rigidity, weaken, and become loose, slack, or flabby over time. The loose cartilage rings pull on the soft membrane, and as your dog inhales (inspirates) or exhales (expirates), the tracheal rings flatten, making it harder for air to reach the lungs. Tracheal collapse on inspiration is called cervical trachea collapse. While tracheal collapse on expiration is called thoracic trachea collapse. This flattening can also affect the lower airways (called mainstem bronchi collapse). Tracheal collapse most often occurs in middle-aged, small (or toy) breed dogs. Tracheal collapse is a chronic and progressive disease with no known cure.

Causes of Tracheal Collapse

Small-breed (or toy breeds) dogs, such as the Shih Tzu, the Chihuahua, Lhasa Apsos the Pomeranian, the Toy Poodle, and the Yorkshire Terrier, are generally the breeds most affected by Tracheal collapse. Because Yorkiepoos are a hybrid of the Toy Poodle and the Yorkshire Terrier, they are at risk for the condition as well. Middle-aged and senior dogs are the most affected with the most common age range for dogs affected by tracheal collapse between 4-15 years. Yorkiepoos are often diagnosed with tracheal collapse as young adults (1-3 years old). Puppies and large breed dogs can also develop tracheal collapse, but this is rare. Because tracheal collapse seems to primarily affect small breed dogs like the Yorkiepoo, a genetic predisposition to weakening of the cartilage in the trachea is suspected.

The cause of tracheal collapse in dogs is unknown, but risk factors for tracheal collapse include obesity, too much activity, a history of respiratory infections, and age. Mainstem bronchial collapse is the collapse of the lower airways. It falls under the umbrella description of Bronchomalacia (BM) or canine bronchomalacia (CBM). Unlike tracheal collapse, mainstem bronchial collapse requires advanced imaging to be diagnosed (usually a bronchoscopy). Risk factors for mainstem bronchial collapse include chronic bronchitis and mitral valve degenerative disorder. There is no direct treatment for mainstem bronchial collapse. Like tracheal collapse, mainstem bronchi collapse is considered a genetic disease.

Laryngeal collapse or laryngeal paralysis is a disease of the upper airway. Laryngeal collapse occurs when the cartilage of the upper larynx doesn't open and close properly, blocking the airway. Unlike, tracheal collapse laryngeal collapse does not appear to be hereditary. Laryngeal collapse is most often a condition acquired by middle-aged or senior large breed dogs. However laryngeal collapse was found to be present in 30% of dogs diagnosed with tracheal collapse. Like tracheal collapse, treatment of laryngeal collapse depends on the severity of the collapse and may include surgical intervention. Diagnosis of tracheal collapse usually involves a physical examination of your Yorkiepoo, along with an examination of the upper airways with an endoscope.

How Tracheal Collapse Affects Your Yorkiepoo

Dogs with tracheal collapse can have a chronic dry cough (described as a "honking cough" that resembles the sounds a goose makes), labored breathing, and wheezing. Coughs from tracheal collapse are generally non-productive, with no phlegm present. Fever is also not usually present with tracheal collapse-induced coughing. The act of breathing can be affected during inhalation and exhalation. The struggle to breathe can become worse for your Yorkipoo during exercise, eating, drinking water, or when they become excited, anxious, or stressed. Or if your dog is exposed to extreme hot or cold temperatures.

Other symptoms of tracheal collapse can include retching, gagging, vomiting, fainting, and blue-tinged gums. Coughing may or may not become worse at night while Yorkiepos are sleeping or resting. Once coughing begins, the irritation to the trachea resumes. These coughing bouts can be violent but do not last most of the time, and your dog can usually get through them without intervention. Sometimes, the increased resistance of the tracheal rings can cause chronic apoxia (critical limitation of oxygen) which can lead to enlargement of the right side of the heart (hypertrophy). If your Yorkipoo begins to show any sign of severe respiratory distress (turning blue, collapsing, struggling to breathe, and fainting), take them to the vet immediately.

Life Expectancy of a Yorkiepoo with Tracheal Collapse

Because of the progressive nature of tracheal collapse, surgical and medicinal intervention is often viewed as palliative. However, medical management can be effective in up to 70% of dogs, and most dogs benefit from a combination of medication and surgery. There is no cure for tracheal collapse, but the prognosis can be good with early diagnosis and medical care. Life expectancy truly depends on how well your Yorkiepoo responds to therapy and can vary depending on the severity (Grade) of the illness. Most dogs continue to live relatively normal lives (15-30% of dogs do not respond to treatment), though occasional bouts of coughing should be expected. Concurrent medical issues such as congestive heart failure (heart disease), or enlarged liver (liver disease).

Elongated soft palate is another medical condition associated with tracheal collapse. Elongated soft palate (the soft part of the roof of the mouth) is when the soft palate becomes too long for the mouth and blocks the entrance to the trachea.  The above conditions can complicate the long-term prognosis of tracheal collapse. Even with medical and surgical intervention, most dogs with tracheal collapse will continue to experience bouts of coughing.

Signs Your Yorkiepoo has Tracheal Collapse

The clinical signs of tracheal collapse are not unique. Various  illnesses such as kennel cough, upper respiratory infection, and bronchial collapse can often have the same symptoms as can congestive heart failure. Tracheal collapse and congestive heart failure are often present simultaneously. Your vet will sit down with you to go over your Yorkiepoos medical history and rule out other possible causes for your dog's labored breathing. Diagnosis of tracheal collapse involves your vet running blood work and doing a physical exam on your dog. Your vet will apply light pressure to your Yorkiepoo's trachea.

If your Yorkiepoo begins to cough or experiences difficulty breathing, tracheal collapse is usually suspected. Your vet will run tests such as fluoroscopy (a type of X-ray that captures images moving in real time as opposed to traditional X-ray still images) and use an endoscope or bronchoscope to confirm the diagnosis. Though the initial symptoms of tracheal collapse can range from mild to severe, the condition worsens over time. Tracheal collapse can be life-threatening if left untreated. A visit to the vet is required to diagnose and grade your Yorkipoo's tracheal collapse properly. Tracheal collapse is classified into four grades:

Grade I 

The cells that form the tracheal lumen, the structure that supports your dog's trachea, are reduced by 25%. The trachea is still normally shaped at this Grade and does not usually require surgical intervention.

Grade II

The tracheal lumen is reduced by 50%, and the cartilage is partially flattened. While more advanced than Grade I, Grade II is still considered manageable without surgical intervention.

Grade III 

The tracheal lumen is reduced approximately 75%, with the cartilage almost entirely flattened. At Grade III, surgical intervention may likely be necessary.

Grade IV 

The tracheal lumen is completely collapsed, and the cartilage is flat. Surgical intervention is necessary.

How To Care For Your Yoorkiepoo with Tracheal Collapse

Environmental factors can increase coughing in dogs with tracheal collapse. Your Yorkiepoo should avoid airborne irritants such as cigarette smoke and strong scents. If you smoke, avoid smoking around your Yorkipoo. Also, avoid wearing perfumes or using strong scented candles or air fresheners around your Yorkiepoo.  Keep your home free of dust and reduce exposure to outside allergens by investing in a HEPA filtration system and keeping your home well ventilated. Extreme cold or hot temperatures can exacerbate your dog's coughing, specifically hot and humid weather. During the summer months, avoid taking your dog out during the middle of the day. Take your Yorkiepoo out early in the morning or late at night when it is cooler outside. Installing an air conditioner in your home can help regulate the body temperature of your dog. A scarf, neck warmer, or snood can help protect your dog's neck during walks in the cold winter months.

Alongside genetics, there is a long list of other conditions associated with tracheal collapse and can make symptoms of tracheal collapse worse:

• Heart disease – congenital heart failure

• Dental disease can also play a role in tracheal collapse. Gingivitis (inflammation of the gums), retained deciduous teeth (baby teeth), and Osteomyelitis (infection of the jaw bone) have all been shown to be connected to tracheal collapse.

• Liver disease – a connection between dogs with tracheal collapse and liver disease (enlarged liver) has also been found. A study on 26 dogs with tracheal collapse found that 92% of them had abnormal liver function due to poor oxygenation.

• Obesity – Obesity can play a direct role in the severity of tracheal collapse in Yorkiepoos. Weight management is an essential part of care for tracheal collapse.

If your Yorkipoo is overweight, weight loss through diet and light exercise is greatly encouraged. Exercise has both benefits and risks for dogs with tracheal collapse. Running, jumping, or high-intensity activities are not recommended for dogs with tracheal collapse. Walks should be modified to slow lead walks. Collar leashes (which can sometimes press or push against the throat) should be swapped out for harness leashes to reduce the amount of pressure placed on your Yorkiepoo's neck and ease coughing.

In severe cases of tracheal collapse (think Grades III and IV), medication and environmental modification may not be enough. Surgical treatment is almost always necessary for a Yorkiepoo with a wholly collapsed trachea. There are a few methods for surgical correction of a collapsed trachea. Tracheal surgery is complex and will need to be done by a board-certified veterinary surgeon. The most minimally invasive procedure for correcting tracheal collapse is called an Intraluminal Stent and involves the implantation of a stent inside the trachea. The implantable tracheal stent is self-expanding tubes made of woven mesh material. The stent is inserted into the trachea to support it and prevent further collapse. Most dogs will have a 75-90% improvement after this procedure. Placement of a stent requires general anesthesia with fluoroscopy beforehand. Your vet will measure your dog's trachea to decide on the appropriately sized stent.

Ring Prosthesis (Extraluminal Trachea Ring) is a less standard procedure involving plastic rings that are fastened around the external surface of the trachea to help prevent further collapse. The success of this procedure can be 75-85%. This procedure is only helpful if the collapse is in the neck and not further down the trachea. Tracheal stents are considered salvage procedures for total tracheal collapse. And while these procedures can improve the quality of your dog's life, they do not cure tracheal collapse. Deterioration over time of the trachea can continue even after surgical correction. Often after a stent has been placed in the trachea, medication is still needed to manage the condition. Tracheal stent procedures are not recommended for dogs with less severe tracheal collapse (Grades I and II) or who have other underlying health issues, such as respiratory infection and heart failure.

Complications from stent surgery can include stent fracture (stent can usually stabilize fractures with a second mesh stent), laryngeal paralysis, stent migration (movement of the stent), tracheal rupture, and stent shortening. Pneumonia can also be a possible complication. Although rare, some dogs are at risk for death after stent placement. If mainstem bronchial collapse is also present, the prognosis for stent placement is more complicated.  Currently, there is no clinically used method for stenting bronchial collapse. And dogs with both tracheal and bronchial collapse may not benefit from surgical intervention.

However, a recent publication concluded that the use of Intramural stents in dogs with bronchial collapse was shown to be helpful. Because of the contradictory information surrounding the surgical correction of bronchial collapse, it is vital to speak with your vet about what options for treatment are best for your Yorkiepoo.

How To Help Your Yorkiepoo Live a Fulfilling Life with Tracheal Collapse

Along with medical intervention, there are homeopathic aids you can use to help improve the quality of your Yorkiepoo's life with tracheal collapse. Adding foods rich in antioxidants and Omega-3 fatty acids (such as fish and green leafy vegetables) into your dog's diet are natural ways to help reduce inflammation. Controlling stress is an integral part of managing tracheal collapse in Yorkiepoos CBD oil or CBD supplements may help reduce your dog's anxiety and stress levels and prevent coughing. However, studies on the effectiveness of CBD oil or supplements for stress reduction in dogs have so far yielded inconclusive results.

Glucosamine and chondroitin can also be great additions to your dog's care regimen and can support the health of your dog's tracheal cartilage. As stated previously, weight plays a vital role in your dog's health – both overall and in managing tracheal collapse. Overweight dogs have difficulty breathing, and being overweight contributes to the chronic cough associated with tracheal collapse. Even in a dog as small as a Yorkiepoo, a 1/4- 1/2lb weight loss can make a massive difference in the stress placed on the trachea. Dogs with tracheal collapse are often exercise-resistant. Understandably so, since exercise often exacerbates symptoms. As mentioned earlier, long slow lead walks at the beginning or end of the day can do wonders to help with weight management and/or weight loss.

If your Yorkiepoo is diagnosed with tracheal collapse, don't panic. Though tracheal collapse may seem scary it's not necessarily a death sentence for your dog. With a thoughtful care plan in place, your Yorkiepoo can still lead a happy and fulfilled life with tracheal collapse. Most dogs diagnosed with tracheal collapse do not experience a decrease in quality of life or life expectancy. He or she will need more medical care and more attention paid to his or her daily lifestyle, but with all of the medical and homeopathic options mentioned above, your Yorkiepoo can thrive.