# A cross-sectional study into the prevalence and conformational risk factors of BOAS across fourteen brachycephalic dog breeds

**Authors:** Francesca Tomlinson, Nai-Chieh Liu, David R. Sargan, Jane F. Ladlow, James Cray Jr, James Cray Jr, James Cray Jr

PMC · DOI: 10.1371/journal.pone.0340604 · PLOS One · 2026-02-18

## TL;DR

This study examines how common BOAS is in 14 short-faced dog breeds and finds that more extreme facial features and weight are linked to higher risk.

## Contribution

The study expands BOAS research to 14 brachycephalic dog breeds and identifies key conformational risk factors across breeds.

## Key findings

- Pekingese and Japanese Chin had the highest rates of BOAS, with only 10.9% and 17.4% being Grade 0, respectively.
- Higher body condition score, nostril stenosis, and lower craniofacial ratio were significantly correlated with BOAS.
- Some breeds, like the King Charles Spaniel, had lower BOAS rates than expected based on their conformation.

## Abstract

Brachycephalic Obstructive Airway Syndrome (BOAS) is known to occur as a common condition in short-skulled (brachycephalic) dogs, but has been intensively studied only in three breeds: the Bulldog, French Bulldog and Pug. This study investigates the frequency and severity of BOAS in a further 14 breeds in the UK pet population: Affenpinscher, Boston Terrier, Boxer, Cavalier King Charles Spaniel, Chihuahua, Dogue de Bordeaux, Griffon Bruxellois, Japanese Chin, King Charles Spaniel, Maltese, Pekingese, Pomeranian, Shih Tzu and Staffordshire Bull Terrier. The respiratory functional grading (RFG) assessment was adapted for use in these breeds, noting respiratory characteristics for 898 dogs in this study. Conformational parameters were measured to analyse the association with BOAS risk. Statistical analysis was performed both comparatively across the 14 breeds and within each breed. Almost every breed in this study had some detectable level of breathing abnormality. Only the Maltese and Pomeranian had no dogs with clinically significant disease. The Pekingese and Japanese Chin, had the highest rates of BOAS with only 10.9% and 17.4% being Grade 0 respectively. Across the whole study population, three factors were significantly correlated with BOAS: higher body condition score, nostril stenosis, and lower craniofacial ratio (more extreme facial hypoplasia). These parameters accounted for 20% of the variation in BOAS status when modelled in multiple logistic regression. It was noted that some extremely flat-faced breeds, for example the King Charles Spaniel, had lower rates of BOAS than expected based on their conformation. Overall, the frequency of BOAS varies considerably by breed. Broadly speaking, more extreme brachycephaly, nostril stenosis and high body condition score are associated with increased BOAS risk. However, with variation of phenotype between the breeds, the findings of this study advocate for a breed-specific approach when tackling the reduction of the disease on a population level.

## Linked entities

- **Species:** Canis lupus familiaris (taxon 9615)

## Full-text entities

- **Genes:** ADAMTS3 (ADAM metallopeptidase with thrombospondin type 1 motif 3) [NCBI Gene 482192], DVL2 (dishevelled segment polarity protein 2) [NCBI Gene 489464]
- **Diseases:** ocular disease (MESH:D005128), mandibular prognathism (MESH:D008313), breathing dysfunction (MESH:D012891), nasal obstruction (MESH:D015508), neurological pathology (MESH:D005598), tracheal hypoplasia (MESH:D014133), underweight (MESH:D013851), Stridor (MESH:D012135), cough (MESH:D003371), weight loss (MESH:D015431), dental malocclusions (MESH:D008310), death (MESH:D003643), facial hypoplasia (MESH:D005155), collapse (MESH:D001261), Brachycephaly (MESH:D003398), BOAS (MESH:D000402), Nostril stenosis (MESH:D003251), Chiari-like malformation (MESH:D001139), respiratory distress (MESH:D012128), CFR (MESH:D005157), airway disease (MESH:D029424), skin fold dermatitis (MESH:D003872), overweight (MESH:D050177), respiratory (MESH:D012131), cardiopulmonary disease (MESH:D006323), dystocia (MESH:D004420), breathing abnormality (MESH:D004417), BCS (MESH:D057215), cyanosis (MESH:D003490), cerebrospinal (MESH:D002559), respiratory disease (MESH:D012140), brachycephalic disease (MESH:D004194), hypoplastic trachea (MESH:D055090)
- **Chemicals:** PONE-D-25-24732R1 (-)
- **Species:** Chloroclystis (pugs, genus) [taxon 190336], Homo sapiens (human, species) [taxon 9606], Canis lupus familiaris (dog, subspecies) [taxon 9615]

## Full text

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## Figures

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## References

44 references — full list in the complete paper: https://tomesphere.com/paper/PMC12915975/full.md

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Source: https://tomesphere.com/paper/PMC12915975