"Breathing issues can escalate quickly, and recognizing the earliest signs can make all the difference."— Julie Schwenzer
Episode summary
Dr. LoSasso opens with a diagnostic distinction most owners never think about: whether a pet struggles more to breathe in or breathe out actually points to where the problem is. Trouble breathing in usually signals an upper-airway issue — his example is an older Labrador with geriatric-onset laryngeal paralysis and polyneuropathy (GOLPP), where a functional obstruction near the voice box makes it hard to pull air in. Trouble breathing out points the other direction, toward the lungs themselves — pneumonia and heart failure patients typically struggle more on the exhale, the same pattern seen in feline asthma.
Increased abdominal effort while breathing is another tell — dogs normally breathe mostly by moving the chest, so visible belly movement means they're working harder than they should be. A practical, almost counterintuitive sign he uses clinically: whether a heart failure patient is willing to eat. Swallowing requires briefly holding your breath, so a dog that starts eating again is usually breathing more comfortably than when it arrived.
"We don't like to see a cat that is open-mouth breathing. Yes, sometimes they'll pant if they get really hot — but honestly, even here in North Texas, we don't see that many panting cats. It's 100 degrees today."— Dr. Michael LoSasso, DVM
Cats get a specific warning: open-mouth breathing is not a normal heat response the way panting is in dogs, and should be taken seriously whenever it happens. He also flags a heart-failure pattern unique to cats — instead of fluid collecting inside the lungs, cats often accumulate fluid around the lungs, physically restricting how much the lungs can inflate.
Brachycephalic breeds — English and French Bulldogs, Shar-Peis, Boxers, Pit Bulls, Lhasa Apsos, Pekingese, Boston Terriers — often have a narrow trachea or excess redundant tissue in the roof of the mouth, both of which compromise airflow from birth. Because these breeds are also naturally noisy breathers, Dr. LoSasso says owners have to judge against their own dog's normal baseline rather than assuming loud breathing is automatically fine — or automatically alarming. And since dogs release heat mainly through the respiratory tract, a compromised airway means less capacity to dump heat, which is exactly why brachycephalic dogs shouldn't be left outside for any real length of time in Texas summer heat, even dogs that clearly want to be out there.
In the ER, evaluation centers on mucous membrane color, respiratory rate and effort, and oxygen saturation (SpO2) via pulse oximeter — placed on the lip, ear, or wherever's accessible, targeting a 98-100% reading. Treatment depends entirely on the underlying cause: oxygen therapy (a climate-controlled ICU chamber reaching about 45% oxygen versus 19% in room air, intranasal cannulas for larger dogs, or high-flow humidified oxygen for severe cases like smoke inhalation); physically draining fluid that's compressing the lungs from outside; diuretics for fluid inside the lungs from heart failure; or antibiotics plus oxygen for pneumonia. He shares a memorable case: an English Bulldog-Pit Bull mix with pyothorax — a pus-filled chest cavity, likely from a migrating plant foreign body — that needed chest tubes on both sides of her chest and five days of hospitalization before she recovered and went home, a case he wasn't initially confident would end well.
Questions answered in this episode
The following questions are answered by Dr. LoSasso in this episode, drawn directly from the conversation. These are real clinical answers from a practicing emergency veterinarian with 30+ years of experience.