Acu in Practice: Collapsing Trachea
Welcome to Acu in practice! Last Friday I had the pleasure of speaking at the Vegas Pug Party, with almost 200 pugs and their owners attending. The brunch was fabulous and so was the “pug” fashion. However, the main reason for my invite was to speak on the pug - specific syndromes that can be improved or alleviated with acupuncture and Traditional Chinese Medicine. We discussed many syndromes that pugs may be predisposed to including airway complications, allergies and dermatitis, mast cell tumors, intervertebral disc disease and idiopathic neuropathy. Respiratory and airway complications are present in almost every pug at some stage of their life. Today I am going to specifically address chronic and progressive tracheal collapse.
This form of collapsing trachea typically occurs as the dog ages and after years of intense negative pressure on the trachea. The negative pressure is more intense in brachycephalic breeds due to their increased respiratory effort on both inspiration and expiration. The trachea is made up of C-shaped cartilaginous rings that are open on the dorsal aspect (top side). The dorsal aspect is bridged by smooth muscle and the rings are connected by ligament. We know from Western research that dogs with collapsing trachea have reduced glycosaminoglycan, glycoprotein and chondroitin in their tracheal rings. However, not much attention has been spent on addressing the smooth muscle at the dorsal aspect. This muscle, and the trachea in general, is supplied by the recurrent laryngeal nerve (parasympathetic, a branch of the vagal nerve) and the middle cervical ganglion (sympathetic) associated most closely with the C5-C6 cervical region. As the trachea continues into the thorax, it is associated with the cervicothoracic nerves. Acupuncture and electroacupuncture can be used to strengthen the muscle, stimulate the nerves and reduce discomfort associated with tracheal collapse by using these nervous pathways and local acupuncture points.
From the Chinese Medicine perspective, this type of collapsing trachea will include a diagnosis of Blood deficiency and possibly Yin Deficiency, leading to Wei syndrome. A full TCM exam and consultation is the best way to determine the specific patterns of deficiency in each dog leading to the condition. However, there are acupoints that can be used in general based on the local and segmental neurologic component. With the integrative medicine model, acupuncture and herbs are combined with surgical and/or medical management to treat this chronic, progressive disease.
Example acupuncture strategy:
Traditional needle technique:
GB 20, BL 10, GV 16 – proximity to vagal nerve
LI 16, LI 17, LI 18, ST 10– association with C4-6 as well as proximity to recurrent laryngeal nerve
GV 14 – association with C6
Needling and/or electrostimulation:
BL 11, BL 12 – association with cervicothoracic nerves, consider electroacupuncture using 40 Hz continuous or intermittent for muscle and dense disperse method at 80-120 Hz for nerve stimulation.
I have also used electrostimulation on ST 10, LI 18 but it is not always well tolerated and ST 10 can be very difficult to find in a pug with lots of wrinkly skin.
Additional points and herbal formulas would be chosen based on the specific patterns diagnosed for each individual patient. Acupoints for reducing inflammation and opening airways are often included in the plan.
Food therapy – nourish the Blood, Liver (ligaments, tendons) and Spleen (muscle)
Additional support to consider on a case by case basis:
Surgical intervention – directly related to the trachea as well as surgeries to reduce respiratory effort associated with stenotic nares and elongated soft palate.
Polysulfated glycosaminoglycan (PSGAG) – injectable, following dosages on label.
Glucosamine chondroitin products or collagen products that are third party tested and provide access to research/efficacy studies.
Standard Process Musculoskeletal Support formula and/or Standard Process Ligaplex II.
Steroid anti-inflammatories when absolutely necessary to reduce inflammation of mucosa during flare ups.
Antitussives when necessary to control cough – herbal and/or pharmaceutical.
Tracheal collapse can occur in any breed of dog but is more commonly seen in small breeds or breeds with consistent respiratory difficulties. It may be congenital, progressive, or age related and may also have an allergic or bacterial component. It is a complicated and frustrating syndrome. In the author’s practice, I combine all viable and helpful treatment options, both Conventional and Alternative, in order to strive for the best results in my patients. This will vary based on the individual patient and underlying deficiencies or disease.
This post was created by Nell Ostermeier, DVM, CVA, FAAVA and is intended for informational use, not to replace medical advice.