Paroxysmal Respiration


Paroxysmal respiration

Q: I have a five year old chihuahua that has symptoms of an asthma attack. She gasps for air, produces snorting sounds while inhaling, clenches her mouth, her entire body stiffens, and she struggles to stand up. Is this asthma or is this some other condition that I am describing? She has these attacks often when she gets excited and sometimes for no apparent reason. Is there a medication that she should be taking, or some other form of treatment?

A: tmd- The most likely causes of the symptoms you are seeing are paroxysmal respiration, collapsing trachea and upper airway obstructions. Paroxysmal respiration is often described as a "reverse sneeze" because it really does look as if a dog is trying to inhale a sneeze when this occurs. If there is a known underlying cause of these attacks I am not aware of it. Collapsing trachea is common in small breeds but normally produces a honking cough. It is probably not the problem but has to be included in the list of "suspects". Upper airway obstructions can occur at the nostrils, nasal passages or the soft palate. These are also pretty common in the small and short nosed breeds.

The best approach to this problem would be to videotape a couple of instances of the problem and take the videotape to your vet. It is hard to get problems like this to occur in the veterinarian's office so a videotape is good insurance that your vet will at least get to see what is happening. Treatment may not be necessary but your vet will also be able to help decide that after seeing what is going on.

Mike Richards, DVM

Paroxysmal respiration, or reverse sneezing, and collapsing trachea syndrome

Question: Dr. Mike,

Can you tell me if there is a relationship between reverse sneezing and tracheal collapse? Most of the articles I've read say that the causes of reverse sneezing may include allergies, post-nasal drip, viruses, or infections. However, I've come across a few articles that equate reverse sneezing with tracheal collapse or obstruction.

Are the authors confusing the conditions because they both produce a honking-type sound, or is there a correlation? I wrote you recently about my dog's cough (possibly due to tracheal irritation), and now he has begun reverse sneezing once or twice a day. Naturally, I am concerned.

Thank you so much for the time you put into answering our questions. You are appreciated.

Amy (Scout's Mom)

Answer: Amy-

I am certain that the condition referred to as inspiratory paroxysmal respiration, or reverse sneezing, and collapsing trachea syndrome are totally different conditions.

However, I think that the symptoms of these conditions are very similar in some cases, though. Especially in dogs with severe coughing episodes associated with the tracheal collapse, which can look a lot like the extreme inspiratory effort that is typical of reverse sneezing.

There are other reasons for confusion between these conditions. They both occur most commonly in small breed dogs and it is likely that there are a number of dogs who have both conditions. Tracheal collapse can be aggravated by any other condition affecting the respiratory tract, making it possible for a dog with reverse sneezing to develop tracheal collapse symptoms over time.

I think that there are probably a number of causes of reverse sneezing and that many cases occur for no discernible reason. According to the "Textbook of Veterinary Internal Medicine" by Ettinger and Feldman, swallowing stops attacks of reverse sneezing. This source says that reverse sneezing may be controlled by massaging the pharyngeal area or briefly closing the dog's nostrils. Several of my clients have mentioned that their dogs respond to rubbing of the upper neck region, so this advice may be useful. Reverse sneezing is a problem of the pharyngeal region.

Tracheal collapse is a problem that occurs because of improper formation of the tracheal rings. Weakness in the tracheal rings leads to a condition in which the trachea collapses, either during inspiration or expiration, depending on the location of the problem in the trachea. This is highly irritating to the dog and coughing results.

Reverse sneezing tends to start at an early age and to be a persistent problem. Tracheal collapse may cause some symptoms at an early age but in most patients there is a gradual increase in coughing over time and it may reach a point in which there are coughing episodes that last for several minutes and do resemble reverse sneezing. Severe tracheal collapse symptoms are more common in older dogs.

Mike Richards, DVM 10/26/2000

Reverse Sneeze

Q: We have a 4 year old spayed female mixed breed dog (most likely german shepherd and lab) that was recently in a kennel for a week - we picked her up on 12/31/96. She is normally active and a very healthy dog. She is very current on all the standard vaccinations and takes Program flea control and Interceptor monthly. Since we got her home she has been very lethargic (which makes sense -- she is probably pooped!) but has also been sneezing and kind of blowing out through her nose in a sort of half sneeze. She does this almost constantly while she is awake and moving around. Another side note: while she is sleeping (most of the time) she seems to be having very vivid dreams - she kicks her feet, moves her legs, twitches and wimpers a little. Is this anything we should be concerned about?

We have not changed anything in the house that would cause an allergic reaction that we can think of. Should we just wait it out a week or so, or does it sound like we should see the vet? Do you have any advice?

A: Dogs have a condition called "paroxysmal respiration" that may be what you are describing. It is also sometimes called a "reverse sneeze" because it really sort of looks like the dog is trying to inhale a sneeze. They tend to look almost like they are having difficulty catching their breath and there is usually a snorting type sound. It is unusual for dogs to do this more than once or twice a day when they are affected with the problem, though. If the description above does fit what your dog is doing, I think it would be a good idea to have your vet examine him because of the frequent episodes you are seeing. This problem does seem to be exacerbated by allergies and it can be difficult to determine exactly what they are allergic to.

Another possibility might be an upper respiratory bacterial or viral infection. A more common form of this would be kennel cough but once in a while we see dogs whose primary symptoms are sneezing and snuffling rather than coughing. Most dogs with either condition are lethargic, much like we are when we have a cold or the flu. These conditions are usually transient and waiting is generally acceptable as long as your dog doesn't seem to be too ill. Signs like refusing to eat, difficulty breathing or extreme lethargy would be cause to seek veterinary attention for these problems, too.

Once in a while we see sneezing and apparent breathing problems related to a foreign body, like a bone or stick, wedged between the upper teeth. This happens when the dog bites through the object but the portion between the two rows of teeth stays caught between them, lodged against the roof of the dog's mouth. It would be worth looking just to be sure nothing like this happened.

I can't relate any of the above problems to the increase in dreaming activity.

If you're worried, having your vet check your dog can be reassuring. If you chose to wait, just be sure that you don't ignore any signs that the problem is getting worse instead of better

Mike Richards, DVM

Snorting and Snoring - Paroxysmal Respiration?

Q: Dear Dr. Mike:

My 3 year old Schnoodle has had a noticeable change in her breathing sounds (snorting and snoring) and she sneezes several times a day (and rubs her nose more often). It started about 6 weeks ago and has continued. I took her to her vet right before Christmas, and the vet asked me about allergies since everything else seemed to be OK (clear lungs, no discharge). It just seems like she has a hard time breathing through her nose and if there is something wrong I'd like to catch it early.

I keep hearing about nasal tumors and it worries me. Is there something you can tell me about the likelihood of this? At what point should I take her to the vet again?

(By the vet did suggest a trial of chlortimeton, 1/2 tab twice a day, to see if this helps, but I haven't tried yet. What do you think?)

Thanks a lot.

A: There is a condition known as paroxysmal respiration (also referred to as a "reverse sneeze" that may be what you are seeing. Most of the time, it is not possible to determine if there is an underlying cause for this problem. There are a number of theories about why it occurs, including abnormalities in the soft palate, allergies, "post-nasal" drip and any other condition that might irritate the palate/laryngeal area.

I always tell my clients to try an antihistamine, too. I have absolutely no idea how well it works, though. One of my own dogs does this and I give her chlorpheniramine (Chlortrimeton Rx) or diphenhydramine (Benedryl Rx) and it seems to help some. I'd give it a try and if it doesn't work, let your vet check your Snoodle again. If something else is wrong it might be easier to find now that it has been around a while..

Mike Richards, DVM


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...