Decision making in BOAS surgery: what can you do to really make a difference to animal welfare?

Brachycephalic Obstructive Airway Syndrome (BOAS) is a progressive disorder resulting from the extreme craniofacial conformation of brachycephalic breeds, such as French Bulldogs, English Bulldogs and Pugs. Anatomic abnormalities, including stenotic nares, an elongated soft palate and hypoplastic trachea, contribute to severe upper airway obstruction and gastrointestinal complications, profoundly impacting the quality of life. Clinical manifestations range from exercise intolerance, respiratory noise, regurgitation, and can progress to life threatening collapse and cyanosis. The clinical signs often beginning in early life and worsen over time. Accurate diagnosis involves a comprehensive clinical history, detailed physical examination and diagnostic techniques such as respiratory function grading and diagnostic imaging, including radiography and computed tomography. Surgical interventions, such as rhinoplasty and staphylectomy (to reduce the length of the soft palate), play a pivotal role in reducing airway resistance, with postoperative improvements reported in 70–90% of cases. However, complications such as aspiration pneumonia, airway obstruction and persistent clinical signs necessitate meticulous patient management. Surgical management often improves the respiratory function of individual dogs, however the majority still remain affected by BOAS and need careful support to manage this, particularly when hospitalised. This review emphasises the importance of early recognition, comprehensive diagnostic evaluation and multidisciplinary management strategies to optimise outcomes for BOAS-affected patients while advancing their overall welfare.