20 Jul 2026
Deborah James RVN looks at how VNs are uniquely placed to detect subtle changes in breathing and the overall comfort of pets suffering with these issues.
Deborah James
Job Title
Image: annaartday / Adobe Stock
Respiratory patients can provide some of the most challenging cases for veterinary nurses to care for. A number of different respiratory diseases can affect different areas of the respiratory tract and can present as acute emergencies that require emergency, critical nursing care or can present as longer-term chronic conditions that require additional management.
The respiratory tract starts at the nose and ends at the alveoli in the lungs with its primary function to provide oxygen to the lungs where gaseous exchange occurs with carbon dioxide. The respiratory tract is divided into two main sections and it includes two subsections, which are:
The upper airways consist of the nose, sinus, pharynx and larynx. Aside from the obvious olfactory sense, the nose also provides thermoregulation and filters particles during inhalation.
The pharynx forms part of both the respiratory and digestive systems and connects the oral cavity to the nose, airway and oesophagus.
The larynx sits on the floor of the pharynx where it divides into the trachea and the oesophagus. It protects the lower airway from aspiration of food and water and produces the voice (Jones, 2021a).
The lower airways consist of the trachea, bronchi and bronchioles. The trachea and bronchi are formed of rings of cartilage and smooth muscle whose purpose is to keep them open and allow air to pass through them.
The lower airways are lined with cilia, which help move mucus towards the pharynx to be swallowed or expelled from the body; and goblet cells, which produce the mucus to moisten air and trap particles. The trachea bifurcates into two bronchi (left and right) that divide into bronchioles, supplying each lung lobe. The end of the bronchioles is attached to an alveolar sac.
The alveolar sac is lined with a membrane surrounded by capillaries, which is where gaseous exchange takes place – oxygen is inhaled and diffuses across the membrane into the blood stream and carbon dioxide is released from the capillaries into the lungs, ready to be exhaled.
The mediastinum is essentially the space between the lungs and is made up of a number of structures, such as the heart, oesophagus, trachea, lymph nodes and nerves, surrounded by connective tissue. Disease processes such as mediastinal neoplasia – for example, lymphoma – are common and can cause the mediastinum to enlarge, compressing lungs and affecting the patient’s respiratory processes.
The pleural space is located between the thoracic wall and the lungs where a very small amount of pleural fluid is present to lubricate the surface and allows the lungs to move during respiration without any friction occurring either against the heart or the wall of the thoracic cavity (Jones, 2021b).
Diseases such as pneumothorax, pleural effusion, pyothorax, chylothorax and haemothorax all occur in this space.
In addition to respiration, the respiratory system is responsible for other functions within the body. These include:
A number of lower airway diseases are commonly seen in practice, both first opinion and referral, and we will look at a couple of them now.
Tracheal collapse occurs where the tracheal rings flatten, and progressive flattening and softening of the cartilage over time results in airway collapse during respiration. Owners commonly complain about their dog having a chronic, loud “honking” cough. Small, miniature and toy breeds such as Yorkshire terriers, Maltese and Chihuahuas are most commonly affected, with diagnoses taking place between 4 to 14 years of age (Uemura et al, 2022). The condition is commonly diagnosed with a combination of clinical history, physical examination, diagnostic imaging and occasionally bronchoalveolar lavage (BAL; Jones, 2021b). Weight management is key here and nurses play a vital role in educating owners in weight control and clinics, and in inhaler training for medications. Antitussives are also a primary treatment option to help control signs, but if patients do not improve, then a tracheal stent can be placed to prevent collapse (Jones, 2021b).
Feline “asthma” or feline bronchial disease is where bronchoconstriction and airway inflammation occurs, causing recurring episodes of wheezing and coughing.
Cats tend to present in respiratory distress or owners report they have been coughing at home. Alongside clinical history, diagnostics include imaging such as radiography, CT or BAL alongside exclusion of other causes such as cardiac disease or neoplasia. Treatment initially involves minimising stress, oxygen therapy and administering bronchodilator agents and sedatives such as butorphanol to reduce stress and aid handling. At home, treatment involves corticosteroids and bronchodilators administered by inhalation therapy as well as weight management. Nurses play a vital role in teaching owners how to use inhalers in a cat-friendly manner and conduct weight clinics to educate owners in the importance of ensuring their cat isn’t overweight.
Brachycephalic obstructive airway syndrome (BOAS) is the most commonly seen upper airway disease in practice. It affects brachycephalic breeds such as French bulldogs and pugs as well as Persians and exotic shorthair cats. BOAS comprises of several congenital abnormalities such as stenotic nares, enlarged and thickened soft palate and an overgrowth of pharyngeal tissue that leads to secondary changes such as everted laryngeal saccules (Jones, 2021c). Patients with BOAS often present with signs such as increased respiratory effort, exercise intolerance, stridor and gagging. The condition is progressive and so treatment is required. Diagnosis involves examining the upper airway, with surgical intervention being required to resect the nares and soft palate and remove the everted saccules if present (Mitze et al, 2022). Postoperatively, patients are often sent home the same day to avoid excessive stress by being in the hospital environment.
If a patient stays in the practice overnight, an emergency airway kit consisting of laryngoscope, induction agent, endotracheal tubes and tracheostomy tubes should be present. Oxygen and pulse oximetry should be utilised until the patient has completely recovered from anaesthesia and even then, for as long as the patient will tolerate.
Layngeal paralysis is a condition commonly seen in older Labradors or golden retrievers and can be idiopathic in origin or subsequent to trauma or injury to the larynx (Jones, 2021c). These dogs often present with stridor and exercise intolerance that is often worse in the warmer, summer months. Direct examination of the larynx is used to diagnose, with thoracic radiography being utilised to exclude other conditions such as megaoesophagus.
Treatment can be medical in mild cases, involving nursing input to manage the patient’s weight and exercise level. For severe cases, surgery such as laryngeal tieback is recommended (Jones, 2021c). Other aspects of nursing care in these cases involve the postoperative period, where slow/gradual meatballs should be fed to the patient. It is important to teach clients to do this as well as this will need to continue until complete healing has occurred. Similarly to BOAS patients, oxygen and emergency airway kits should be available.
Examining and caring for patients with respiratory disease is a key skill in our repertoire. Nurses can advocate for these patients through how they conduct their assessments:
Using these key steps when checking your patients initially develops your nursing skills and confidence – nurses are often the ones conducting the daily checks and monitoring patients and so are best positioned for spotting subtle changes in a patient’s condition.
Minimising handling and maintaining a calm, quiet environment is essential, especially for feline patients that are highly prone to decompensation; nurses should be confident in setting up and managing oxygen therapy while monitoring respiratory rate, effort, and mucous membrane colour.
Careful observation for signs of deterioration allows for rapid treatment to be administered as soon as possible.
Additionally, maintaining hydration, ensuring appropriate positioning to ease breathing, and supporting nutritional needs are key components of nursing care.
Clear communication with veterinary surgeons and accurate record-keeping further ensures that changes in patient status are promptly addressed.
Veterinary nurses play a critical role in both stabilisation and recovery. Veterinary nurses are uniquely positioned to detect subtle changes in breathing patterns, oxygenation and patient comfort, allowing for timely intervention.
Through diligent monitoring, appropriate oxygen therapy, stress minimisation and clear communication with the wider clinical team, nurses can significantly influence patient outcomes.
A thorough understanding of the respiratory system, combined with compassionate, attentive care, ensures that these often-fragile patients receive the support they need.
Deborah James qualified from Hartpury College in 2017 with a BSc in Veterinary Nursing Science and works as team leader at Vets Klinic. She has completed an ISFM Certificate in Feline Nursing and is in the second year of her MSc in Veterinary Nursing at the University of Glasgow.