Pug with BOAS

Photo by Dr. Rowena Packer

A pug diagnosed with brachycephalic obstructive airway syndrome is in respiratory distress. It was seen at Queen Mother Hospital for Animals at the Royal Veterinary College in London in 2011.

Norway soon could become the second country to ban the breeding of short-muzzled dogs, adding weight to calls — including a campaign backed by nearly 1,500 veterinarians — for rule changes worldwide.

The Norwegian Society for the Protection of Animals (NSPA) is suing three kennel clubs in the country, claiming they are breaching existing animal welfare rules by facilitating the breeding of dogs with serious health issues, including those caused by a flattened face, or brachycephaly.

The case, watched closely by kennel clubs around the world, is due to be heard by the Oslo District Court beginning Nov. 10, NSPA chief executive Dr. Åshild Roaldset said.

Brachycephaly (brak-ee-SEH-fuh-lee) is evident in more than a dozen dog breeds, including bulldogs and pugs. It is found in other types of animals, too, such as cats, rabbits and horses, and is desired by owners for cosmetic effect.

Structurally flattened faces are associated with numerous health problems with varying degrees of severity, including brachycephalic obstructive airway syndrome (BOAS). The condition, as its name suggests, causes breathing difficulties and is associated with exhaustion, overheating, regurgitation, sleep apnea and collapse. Snuffling and snoring, considered by some as an endearing characteristic of brachycephalic breeds, can be a sign they are struggling for oxygen — a point the NSPA emphasizes in a campaign video.

The shape of the skull also may cause eyes to protrude, making them prone to injury and infection, and dental problems due to a lack of room in the mouth. Skin infections are common due to skin folds. Affected animals also may struggle to mate, owing to ungainly body shapes and lack of stamina. Brachycephalic breeds also may have difficulty giving birth naturally, since the pup's head may be disproportionally large, requiring cesarean delivery.

Still, moves to introduce breeding restrictions are putting animal-welfare proponents on a collision course with kennel clubs, breeders and dog owners who argue such bans are overreach, in part because not all brachycephalic animals exhibit severe clinical signs.

The lawsuit coming to trial is based on section 25 of the Norwegian Animal Welfare Act of 2009, which states that breeding must produce "robust animals, which function well and have good health." The law also states that breeding shouldn't be carried out in such a way that it passes on genes that negatively influence an animal's physical or mental function.

The NSPA believes the rules are clear. "We initially went to the kennel clubs, the breeders and the regulator, but they effectively did nothing — so we decided there is no other option than to test the law in court," Roaldset said.

Kjetil V. Johansen, a media and policy adviser for the Norwegian Kennel Club, said the club prefers not to comment on the matter until the case is heard in November.

A win for the charity would see Norway join the Netherlands, which commissioned a report by veterinarians, produced in 2019, to clarify the country's existing anti-brachycephaly law, and pledged to enforce it. The move prompted the Dutch Kennel Club last year to become the first kennel club in the world to end registration for certain brachycephalic breeds; in its case 12, including English bulldogs, French bulldogs, pugs, cavalier King Charles spaniels and Boston terriers. The Dutch club, however, was able to secure an exception that enables short-snouted dogs to breed with dogs possessing longer muzzles.

Despite the concession it won, the Dutch club's move outraged many other clubs around the world, including the Pug Breed Council in the United Kingdom, which accused it of "being happy to see the demise of historic breeds that have existed for hundreds of years." The American Kennel Club said it was "extremely concerned," and wrote a letter to the Dutch group urging it to "aggressively work against these overt attempts to control breed type" and pursue "thoughtful ways to address health issues within a breed.”

Veterinarian voices grow louder, though attitudes vary

Separately, a lobbying campaign started in 2017 by the British veterinarian and animal welfare supporter Dr. Emma Goodman Milne has, as of today, amassed the signatures of 1,462 veterinarians in 66 countries and the endorsement of several professional organizations, including the World Small Animal Veterinary Association and the Federation of European Companion Animal Veterinary Associations.

"Basically, the idea is for the campaign to be a perpetual standing letter that vets around the world can use to show how strongly they feel about brachycephalism," Goodman Milne, who now lives in southern France, said. "It's really hard to get new laws passed, and we need vets to stand up and say, 'These animals are suffering.' "

Veterinarians' views on brachycephaly aren't uniform, though most practitioners appear to be wary of the associated health risks. In 2019, on a message board of the Veterinary Information Network, an online community for the profession and parent of the VIN News Service, many practitioners said they don't find brachycephalic breeds "cute," considering all the operations they've had to perform on them. Some supported the idea of breed bans. Others suggested that rules or educational campaigns should focus on breeding brachycephalic dogs with less severe deformities.

"A poorly bred Labrador retriever can be just as much of a mess physically as a bulldog, all while looking ‘normal,' " Dr. Kevin Jepsen-Grant, who posted on VIN about the subject, said in an interview. "I still don't think bans on certain breeds or lookalikes is the right way to go."

Jepsen-Grant, a companion animal practitioner in California, acknowledged that achieving better outcomes within breeds has its own challenges. "How we go about encouraging healthy bred canines, whether they are purebred or mixes, I don't know," he said.

Early on, interest in the Vets Against Brachycephalism campaign came from practitioners in the U.K. and countries on the European mainland. Participation has since expanded to Africa, the Americas, Asia, Australasia and the Middle East. "It comes in waves," Goodman Milne said. "Suddenly, a few weeks ago, I had 250-odd vets from Paraguay and Uruguay and other places in South America sign up." The reason, she learned later, is that a local newspaper had published an article about the campaign.

She and other campaigners hope the case in Norway will be a catalyst for change elsewhere. The U.K., for instance, in 2018 updated its animal welfare regulations in a way that implies that breeding brachycephalic animals is illegal there, too. As in Norway, however, the U.K. rules aren't enforced.

The American Kennel Club, meanwhile, last year offered to work with opponents of any proposed bans in the U.S.

"It's absolutely huge, this case in Norway, and we're hoping the NSPA will win," Goodman Milne said. "Hopefully, it will trigger many other prosecutions under existing laws."

In Norway, the NSPA is taking on three kennel clubs and six individual breeders, including the Norwegian Kennel Club and the respective kennel clubs for English bulldogs and cavalier King Charles spaniels (the latter breed also is susceptible to heart disease and syringomyelia, a progressive neurologic condition characterized by pain in the back of the neck). The NSPA's case targets only those two breeds. To comply with existing laws, it argues that should they reproduce, they must be outcrossed with another, healthy breed.

The outcome of the case will depend heavily on scientific arguments: Roaldset said the court will have two expert judges in addition to the main judge — one with a background in veterinary science; the other in genetics. The parties will also bring forward expert witnesses on major diseases of concern.

What is the scientific evidence?

French bulldog

Photo courtesy of the University of Cambridge

A French bulldog's respiratory function is assessed through whole-body barometric plethysmography, a noninvasive technique used to measure breathing patterns.

Dozens of scientific studies have been published about health risks associated with brachycephaly. Some of the most sophisticated work has been carried out by the Cambridge BOAS Research Group, which is based at the University of Cambridge in England and has been investigating respiratory disorders in brachycephalic canine breeds for around a decade. The group applies whole-body barometric plethysmography, which involves placing dogs in transparent chambers and measuring barometric pressure oscillations to assess their respiratory function.

Brachycephalic animals can struggle for oxygen due to having undersized or flattened breathing passages or throats. They also might have an elongated soft palate — which protrudes into the airway and interferes with breathing — and malformed nostrils that make it hard to breathe. Tissue within the airway may also be pulled into the windpipe, further obstructing airflow.

In an often-referenced study published in 2015, the researchers at Cambridge established a grading system for measuring airway obstruction. Grade-zero dogs show no signs of BOAS. Grade-one dogs have mildly noisy breathing but can tolerate exercise. Grade-two dogs have clinically relevant disease that requires veterinary attention such as medical management or surgery. Grade-three dogs are the most severe cases, requiring immediate surgical intervention to address serious breathing difficulties.

In that study, testing was carried out on 89 French bulldogs and 20 non-brachycephalic control dogs. More than half (54%) of the French bulldogs were either grades two or three, or what the researchers described as "BOAS-plus." Just 10% of the French bulldogs were graded BOAS-zero. The majority of owners (60%) failed to recognize the airway problems in BOAS-plus dogs.

Breathing difficulties aside, researchers at the Royal Veterinary College in England have found that brachycephalic breeds are more likely than other breeds to experience eight out of 30 common disorders. These are corneal ulceration, heart murmur, umbilical hernia, pododermatitis, skin cysts, patellar luxation (knee problems), otitis externa (ear infections) and anal sac impaction. The research, published last October, was based on a random sample of 22,333 dogs that entered U.K. veterinary care in 2016, making it the first large-scale direct comparison of the health of brachycephalic versus non-brachycephalic dogs using clinical records. "The results provide strong evidence to support the position that brachycephalic dogs have reduced health overall compared with non-brachycephalic dogs," the researchers concluded.

In the U.S., pet insurer Nationwide published a study in 2017 based on insurance claims for more than 1.27 million dogs over nine years. The study showed that even after excluding conditions common to brachycephalic breeds, such as BOAS, the breeds were less healthy than other dogs. They were more prone, for instance, to suffer from heart disease, pneumonia and gastrointestinal problems.

Goodman Milne said being born with physical disabilities can take a toll on dogs' mental health, too, offering the example of a puppy that can't play as vigorously with its peers in puppy class. "You often hear people saying: 'If you don't want to have to walk your dog much, you can get an English bulldog,' " she said. "Dogs are incredibly stoic animals, and if they're born into a body that doesn't work, they just get on with it. They don't have the means to complain like a human would."

As far as Goodman Milne is concerned, the weight of scientific evidence presents a compelling case for outright breed bans. "We've got more than 200 recognized breeds of dog, and I think if I made a list of breeds that I would consider too extreme to be acceptable on welfare grounds, you'd still have probably 180 breeds of dog to choose from," she said.

She also wonders why, in some cases, pet owners can't be satisfied with mixed breeds. "People in the Western world have become totally obsessed with what breed an animal is, instead of breeding for health and temperament," she said. "All we want at the end of the day are healthy, happy, good-natured family pets."

At the same time, she isn't absolutely opposed to the idea of improvements being made within breeds. "You need outside pressure from the people who say, 'These breeds should be banned,' which is effectively what I'm saying," she said. "Then, if you've got people getting worried that might happen, hopefully, that puts pressure on them to make the breeds healthier and start changing the breed standards meaningfully."

For her part, the NSPA's Roaldset said the charity ultimately wants breeding standards to be based on animal well-being, underpinned by scientific evidence rather than on emotion or tradition. Unsurprisingly, the NSPA welcomed the release in November by the European Union of new guidelines that recommend the use of breeding values for dogs and cats that estimate genetic merits for particular traits. "We need to feed population information into the databases we already have and start using estimated breeding values based on health factors," Roaldset said. "We need to stop selecting dogs on how they look alone."