Health Issues in Brachycephalic Dogs Are Often Missed

Are issues in Bulldogs, French Bulldogs, and Pugs seen as normal for the breed?

Posted Aug 07, 2019

Bulldogs, French Bulldogs, and Pugs are popular small dogs. They have great personalities and many people feel they are especially suitable for modern life. But these breeds have a squashed (brachycephalic) face, which is unfortunately linked to welfare issues. New research by Rowena Packer (Royal Veterinary College) et al, published in PLOS One, shows some surprising disconnects between perception and reality for owners of these three breeds.

A Pug
Source: eduardops93/Pixabay

The survey found a mismatch between people’s perceptions and the dog’s actual health. To put it bluntly, while 70.9 percent said their dog was in "very good health" or "the best health possible," answers on other questions suggest 40 percent of the dogs had clinically-relevant airway impairment.

The scientists write:

“These contrasting and paradoxical results support the influence here of the ‘normalisation’ phenomenon whereby owners of brachycephalic dogs may be consciously aware that the dog is struggling to breathe but not consciously accept that this is a specific problem, instead considering it a ‘normal’ and therefore somehow acceptable feature of the breed.”

While more research is needed to fully understand these results, it seems many people may see their dog’s breathing issues as “cute” or “funny” rather than as health problems, or think their dog is healthier than others of that breed.

Brachycephalic dogs can have difficulty breathing and are susceptible to skin conditions as a result of the folds in the skin on their face and a tendency to allergic skin disease. They are prone to eye conditions such as entropion, a heritable condition in which the eyelid rolls inward. They have an average lifespan of 8.6 years compared to 12.7 years for dogs that are non- or moderately-brachycephalic. So it’s important to understand how people perceive their dogs.

In this study, 19.9 percent of dogs had had at least one surgery related to their conformation (i.e. their looks). The most common surgeries were widening of the nostrils (8.2 percent) or surgery on the eyelids (8 percent). Meanwhile, 7.6 percent had had a soft palate resection because the soft palate was too long for the shortened face.

Other common medical issues were allergies, corneal ulcers, and skin fold infections: 11.8 percent of the dogs had been diagnosed with Brachycephalic Obstructive Airway Syndrome which is characterized by noisy breathing (snoring, snorting), narrow nostrils, eating difficulties, sleep apnea, and struggling to cope with high temperatures.

In the survey, 36.5 percent of people said their dog had difficulty with heat regulation and 17.9 percent said their dog had trouble breathing. Further, 5.1 percent reported problems with eating (e.g. regurgitation, vomiting, or choking), and 2.7 percent reported problems with sleeping (e.g. sleeping with their mouth open, with a toy in the mouth, sitting up, or with the head raised).

Although 17.9 percent reported their dog had difficulty breathing, answers on more specific questions suggest that 40 percent of the dogs had some degree of airway obstruction. This shows the importance of asking specific questions. At the same time, it suggests some people may assume some issues are “normal” for the breed.

Over a third of the bitches in the study had had at least one litter. 43 percent of the French Bulldogs and Bulldogs had required a Caesarian section. In the UK where this study took place, the Kennel Club will not register the puppies of bitches if they have previously had 2 caesarian sections.

Overall, people reported a strong bond with their dogs. People’s perceived emotional closeness to their dog was higher for women, for those with no children, and for people who owned Pugs compared to French Bulldogs. It was lower when the dog’s behavior was worse than they expected, which is interesting because people often choose these breeds because they think they will be easy-going and affectionate. Other research has shown that people whose dogs are better behaved tend to be happier and a study of French Bulldogs based on vet-reported data found aggression was reported in 2.3 percent of them, higher than expected (O’Neill et al 2018).

The perceived costs of dog ownership were higher for first-time dog owners, for the Pug owners, for those whose dog’s health was not so good, and if vet fees, the dog’s behavior, and maintenance levels were worse than the person had expected.

A majority of owners (ranging from 65 to 82 percent) said their dog met their expectations for vet costs, exercise, behavior, and maintenance. Given that many people choose these breeds because of their size, it’s interesting to note that 24.1 percent of owners said their dog needed more exercise than they expected.

The scientists conclude:

“Ownership of brachycephalic dog breeds is a complex phenomenon, characterised by extremely strong dog-owner relationships and unrealistic perceptions of good health set against high levels of disease in relatively young dogs. Perceptual errors in owner beliefs appear to exist between their perspective of their own dog’s health versus the health of the rest of their breed, which may be fuelled by cognitive dissonance processes.”

These results are interesting because in other research, a closer bond with the dog has been linked to the dog receiving more veterinary care, and that does not appear to be the case here. Rather, it seems that many owners of Bulldogs, French Bulldogs, and Pugs, are (either consciously or unconsciously) not noticing health issues in their dog. Earlier research has shown that people who choose brachycephalic breeds are more motivated by the dog’s appearance than people who choose other breeds (Packer et al 2017) and this study shows they may also differ in other ways.

Over 2,000 Pug, Bulldog, or French Bulldog owners, mostly aged 25-34, took part in the online survey. The average age of their dogs was 2.17 years. Because this is not a representative sample, and because the survey is based on owner reports, not veterinary findings, the health issues reported may not reflect the breed overall.

My guidelines on getting a puppy include researching the health of the breed so that you know about the health checks to ask for and any common conditions. If you are concerned about your dog’s health, see your veterinarian.


O’Neill, D. G., Baral, L., Church, D. B., Brodbelt, D. C., & Packer, R. M. (2018). Demography and disorders of the French bulldog population under primary veterinary care in the UK in 2013. Canine genetics and epidemiology, 5(1), 3.

Packer, R. M., O’Neill, D. G., Fletcher, F., & Farnworth, M. J. (2019). Great expectations, inconvenient truths, and the paradoxes of the dog-owner relationship for owners of brachycephalic dogs. PLOS ONE, 14(7), e0219918.

Packer, R. M. A., Murphy, D., & Farnworth, M. J. (2017). Purchasing popular purebreds: investigating the influence of breed-type on the pre-purchase motivations and behaviour of dog owners. Animal Welfare 26(2) 191-201.