BS is a complex mixture of hereditary defects that progress with time to induce secondary changes some of which are not treatable. Selective breeding for a flat-faced conformation has played a significant role in promoting and perpetuating this disease. Traditionally, BS was considered to involve predominantly the airways, hence the use of terms, such as brachycephalic obstructive airway syndrome. However, these patients can suffer adverse effects on several body systems including digestive, skin and eyes in addition to having sleep disorders, exercise and heat intolerance. For this reason, it may be more appropriate to move towards using a broader term such as BS.
The degree of airway obstruction can be alleviated through surgery, which in some cases will be life saving. These patients are challenging anaesthetic candidates, requiring a careful and efficient approach from all staff involved. It is also important to take account of all morbidities present so that all necessary treatment can be provided and a realistic prognosis discussed with clients. Better success is achieved by treating patients early, rather than once severe secondary changes have developed. Unfortunately, there is a serious issue with inability on the part of clients, and perhaps also some clinical signs of BS as being a genuine problem. All too often, something that is truly abnormal is perceived as normal for the breed. This means that assessment and treatment may not be provided in a sufficiently timely manner, and the prognosis consequently suffers. Although there is growing awareness of the potential welfare issues involved, there is clearly still a requirement for education of veterinary professionals, dog breeders and the wider public.