Pugs are thought to be one of the oldest dog breeds, they were first mentioned by Confucius in 551 BC(1). Initially bred as royal companions, they have delightful, clownish personalities. They love human company and being at the centre of family life. Most pugs are exceptionally affectionate, gentle and integrate well with children and other pets. They don’t enjoy long periods alone and are happiest in company. However, over the centuries the conformation (structure) of pugs has altered. 

The changing face of pugs

Records of pugs in the past show they had a longer nose and longer legs. Selective breeding has accentuated the childlike facial features, shortening the nose and skull to produce prominent eyes(1). The short muzzle, undershot mouth (top jaw shorter than the bottom) and curled tail are now included in the Kennel Club breed standard. 

Unfortunately, these characteristics lead to health problems. A book reviewing the diseases prevalent in different dog breeds identifies 25 disorders over-represented in the pug (2). The Kennel Club classify pugs as Category 3 for health and welfare issues – this is the highest risk category. 

There are breeders and pug enthusiasts who are working hard to improve pug health. 

The Kennel Club have introduced a health scheme originated by the Pug Breed Council to health screen pugs prior to mating. As breeding pugs is a lucrative business, not all breeders are concerned with the welfare of the dog but breed for profit. Therefore, many pugs offered for sale in the UK have debilitating health conditions which significantly impact their quality of life. The PDSA, a charity who treat animals belonging to owners with low incomes, strongly recommend buying a different breed or only considering pug crosses. In the rest of this article, we will consider the most common health concerns. 


Dog breeds with short noses are called brachycephalics. Their conformation often causes BOAS (Brachycephalic Obstructive Airway Syndrome). This means that it is difficult for them to breathe. Shortening the skull results in excess tissue in the airway. A long soft palate, large tonsils and a swollen larynx all obstruct the airway. This is exacerbated by narrow, closed or slit-like nostrils. The result is limited airflow to the lungs. If you have ever tried to breathe with a heavy cold and sore throat, you can sympathise with how affected dogs feel all the time. 

Some breeders/sellers will insist that the obstructive breathing snorting and snoring noise are normal. Depending on the severity of the obstruction dogs may breathe noisily at rest or exercise, pant constantly or only when playing or walking. Often these dogs cannot cool themselves down in hot weather and are prone to heat stroke. As many struggle to breathe and swallow simultaneously, they have difficulty eating and may regurgitate food or saliva frequently.  

Big eyes

The prominent eyes of the pug mean that tear flow may be insufficient to lubricate the eye. This can result in dry eyes which are prone to painful ulceration by trauma or infection. Constant irritation of the cornea (surface of the eye) often results in pigment laid down in the eye obscuring vision (pigmentary keratopathy). Shallow eye sockets mean that eyes may be more likely to prolapse (pop out) with trauma or play. Both these conditions can lead to loss of an eye. Eyelid abnormalities (entropion and ectropion) can occur and constantly irritate the cornea.


Pug dog encephalitis (PDE) is a devastating, neurological condition. It is usually fatal. Most cases occur between the ages of 2-3 but it can present from 6 months to 6 years of age. The inflammation of the brain is caused by the dog’s immune system attacking the brain tissue. The disease can progress from depression. head and neck pain, blindness and behavioural change to seizures and death in weeks. It is inherited and even crossbreds with one pug parent can suffer from PDE. 

Spinal problems

Pugs are prone to spinal disease caused by hemivertebrae. The gene that codes for the coils in the tail also causes abnormally shaped vertebrae in other areas of the spine, these are often called hemivertebrae (3). These vertebrae can put pressure on the spinal cord within causing chronic back pain, and sometimes paralysis and incontinence. Severely affected dogs require spinal surgery to remove the pressure on the spinal cord. Many pugs are affected, x-ray or scanning is required to diagnose this cause of chronic pain. 


Pugs are prone to lameness due to luxating patellae (dislocated kneecaps). This means that their kneecaps do not run smoothly within a ridge but slip out, become stuck and stop the hindleg bending. There are 4 grades of patella luxation; in the mild forms the dog may have a loose kneecap that intermittently moves. The more severe grades can result in permanent lameness and require orthopaedic surgery to correct.  

Skin disease

Excessive skin folds can become problematic for pugs as dermatitis is common if they become moist or chafe. Bacteria and yeast love living in skin folds. Keeping them clean and dry can be difficult. Tooth overcrowding is also common because of the short nose and undershot jaw. Dental care must be meticulous as plaque and tartar build-up can be worse on overcrowded teeth leading to periodontal disease.  

These are some of the most common pug disorders. 

Often these conditions are exacerbated by obesity. Pugs are not bred as working dogs, nor do they have a strong prey drive so they can be less active than other dogs. They also have a large appetite, and some are unable to exercise because of breathing difficulties. These two factors can result in obesity, which will make lameness and spinal disease worse.

In conclusion, consider the following if you decide that it is a good idea to buy a pug. 

  • The disease profile of the pug means that insurance premiums are very high. Estimate a monthly premium of £50-80 for pet insurance
  • Do not be tempted by cheaper prices, pugs are often victims of inappropriate breeding, puppy smuggling and puppy farming. These pups and their parents often suffer from owners putting profit being welfare. Always insist on seeing the mother and visiting the pups rather than having one delivered. 
  • Find a breeder who uses the Kennel Club Assured Breeders Scheme, their dogs will have had a respiratory function test, genetic testing for PDE and may have been x-rayed to check for hemivertebrae before breeding. 
  • Choose a lively pup with open, round nostrils. Check the shape of the parents’ nostrils and whether they have had surgery or make any respiratory noise. Buy from a breeder who exercises their dogs regularly and has fit, slim healthy dogs. 

For a pug owner’s point of view, you could do worse than reading – 8 reasons not to get a pug. Covering personality traits, real-life costs and obviously the major upsides too.

Finally, consider a pug cross to enjoy the wonderful temperament but reduce the problems caused by their conformation. 

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References and further reading:

  1. O’Neill DGO, Darwent, EC, Church DB and Brodbelt DC. Demography and health of pugs under primary veterinary care in England. (2016) Canine Genetics and Epidemiology 3 (5) 
  2. Gough A, Thomas A. Breed Predispositions to Disease in Dogs and Cats. Chichester: Wiley-Blackwell; 2010.
  3. LeCouteur R and Grandy J (2000) Diseases of the spinal cord. In Ettinger, S and Feldman, E. (Eds) Textbook of veterinary internal medicine. 5th Ed. Philadelphia: WB Saunders Company