Reverse Sneezing and Noisy Breathing in Shih Tzus: What Is Normal and When to Worry

A Shih Tzu standing stock-still, neck stretched out, pulling in air with a loud snorting honk as if it cannot breathe: the first time you see it, it is frightening. Most of the time it is a reverse sneeze, it is over within a minute, and the dog trots off as if nothing happened. But small, flat-faced dogs make several noises that sound alike, and one or two of them are worth a vet’s attention. This guide is about telling them apart.

What a reverse sneeze is

A normal sneeze pushes air out. A reverse sneeze pulls it in, fast and hard, through the nose, in a run of snorts. Vets think it is the dog’s way of clearing an irritation at the back of the throat. The UK vet charity PDSA describes it as alarming to watch but nearly always harmless, with episodes that usually last 30 to 60 seconds. The PDSA lists an overlong soft palate, common in flat-faced breeds including the Shih Tzu, among the causes.

Which noise is which

What you hear and see	Likely cause	What to do
Loud snorting while breathing in, standing still, neck stretched; normal again within a minute	Reverse sneeze	Stay calm; see below. Mention it to your vet if it is new or getting more frequent
Snoring and snuffling while asleep, quiet when awake and resting	A short nose and a long soft palate	Common in the breed; worth raising at the next check-up
Noisy breathing when awake and calm, tiring early on walks, struggling in warm weather	Possible BOAS, the breathing condition of flat-faced breeds	Vet appointment; this one can be graded and treated
A dry cough like a goose honk, pushing air out, often on excitement or pressure on the neck, usually from middle age	Possible collapsing windpipe (tracheal collapse)	Vet appointment; switch from a collar to a harness now
Gagging, retching, pawing at the mouth	Something stuck	Vet the same day; urgently if the dog cannot settle
Laboured breathing at rest, blue or grey gums or tongue, collapse	Emergency	Call your vet or an emergency clinic now

The direction of the air is the most useful single clue. A reverse sneeze pulls air in; a collapsing windpipe makes a cough that pushes air out. The two can overlap in the same dog, though, so a sound alone is not a diagnosis.

During a reverse sneeze

1. Stay calm and talk quietly. It is not painful, and a dog that is wound up by your alarm tends to keep going.
2. Stroke the throat gently, downwards. Some dogs settle faster with it.
3. Make the dog swallow. Briefly and gently covering the nostrils with your fingers for a second or two often prompts a swallow, which can end the episode. Never hold the muzzle closed or keep it covered.
4. Let it pass. Most episodes stop on their own within a minute whatever you do.
5. Film it if you can. A dog rarely does it in the consulting room, and a ten-second video tells your vet more than any description.

Common triggers, and what helps

• Pulling on a collar. Pressure on the throat sets off reverse sneezing in some dogs and is the one thing a dog with a weak windpipe must avoid. A small, flat-faced dog is better on a well-fitted harness; our harness comparison covers fit.
• Excitement, such as the doorbell, the lead coming out, or you coming home. Calm greetings help.
• Dust, smoke, perfume and air fresheners. A dog’s nose is close to carpets and sprays.
• Eating or drinking fast. Gulping can bring on a bout straight after a meal; our guide to a dog that eats too fast has the fixes.
• Allergies and nasal irritation, which your vet can look for if the episodes are frequent.

Why Shih Tzus, and what the research says

Shih Tzus are a flat-faced (brachycephalic) breed: a short muzzle with the same amount of soft tissue packed into it, often with narrow nostrils and a soft palate long enough to hang into the airway. That is why snorts and snores are so common in the breed, and why a reverse sneeze is more likely than in a long-nosed dog.

A University of Cambridge study published in PLOS One in February 2026 examined nearly 900 dogs from 14 breeds beyond the Pug, French Bulldog and Bulldog. It placed the Shih Tzu in the moderate-risk group for BOAS (brachycephalic obstructive airway syndrome), with roughly half to three-quarters of the dogs examined showing some degree of it. Dogs that were overweight, or had narrowed nostrils, were more likely to be affected.

That can look like it contradicts the large UK vet-records study in our guide to Shih Tzu health, where breathing problems did not appear among the most common diagnoses. The two measure different things. Records count what a vet diagnosed and wrote down; the Cambridge team examined every dog, including the many whose owners had come to think of the noise as normal. The practical point is the same: a Shih Tzu that breathes noisily when awake and calm, or tires early, deserves a proper look.

Two things are within your control. Keep your dog lean, because extra weight narrows an already narrow airway. And if you are choosing a puppy, ask whether the parents have had their breathing checked: the respiratory grading scheme first built for Pugs and Bulldogs now accepts Shih Tzus as well.

When to see a vet

• The first episode ever, to confirm that it was a reverse sneeze. Take the video.
• Episodes getting longer or more frequent, or affecting the dog’s day.
• Nasal discharge, especially from one side, bleeding from the nose, or repeated normal sneezing alongside it.
• Noisy breathing when awake and resting, tiring early, or trouble in warm weather.
• A honking cough, especially in a dog of middle age or older.
• An older dog that starts coughing, breathing fast while asleep, or tiring. Heart disease is common in older small dogs and can sound like a breathing problem; our guide to the older small dog explains how to count the resting breathing rate.

Go now, not tomorrow, if your dog is struggling to breathe at rest, has blue or grey gums or tongue, collapses, or cannot settle after gagging. Flat-faced dogs also overheat quickly; noisy, frantic breathing on a warm day is an emergency, as our guide to walking in the heat explains.

This is general guidance, not veterinary advice. If you are unsure what you are hearing, a short video and a call to your vet is always a reasonable thing to do.