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Health Testing Guide
Which tests are mandatory, how to spot responsible breeders — and what it costs when things go wrong.
For the Pug we've compiled 1 mandatory and 10 recommended health tests, drawn from breed-club regulations, the University of PEI (CIDD), and OMIA — weighted by severity and heritability.
See dogs available for adoptionWhat this grade means
The Pug is classified with a health grade of E, as a large majority of all Pugs show measurable airway restriction due to brachycephalic obstructive airway syndrome (BOAS) and many animals are significantly restricted even under mild exertion or heat. In addition to this severe burden, diseases such as keratoconjunctivitis sicca (KCS), meningitis (SRMA), and complex vertebral malformation (CVM) also occur as breed-typical conditions. Responsible breeders counteract these risks through targeted selection and have their breeding animals comprehensively tested. Before buying a puppy, you should therefore definitely ask to see the test results of the parent animals: a clear result for keratoconjunctivitis sicca (KCS) is required, as well as proof of Grade A for meningitis (SRMA) and complex vertebral malformation (CVM).
Every breed is susceptible to certain inherited conditions. Just like humans, dogs inherit predispositions from their parents. Responsible breeders screen their breeding dogs for these conditions and make informed mating decisions to reduce the risk passed on to puppies.
No — but it's the strongest tool we have. Diet, exercise, environment, and genetics all contribute to whether a dog develops a condition. When breeders use the right tests to identify risk in potential parents, the likelihood of many conditions appearing in the puppies drops significantly.
There's no one-size-fits-all here. For the Pug we track 1 mandatory tests plus 10 additional recommended ones. The specific tests and passing thresholds are detailed further below.
Keep in mind
Reliable screening tests still don't exist for many hereditary conditions, and tests for complex polygenic conditions don't always predict severity in the puppies. Even so, they're a powerful tool of responsible breeding.
There are two main types of health tests:
Screen the dog's DNA for known disease-causing mutations. Can be performed from puppyhood and give a binary result (clear / carrier / affected).
Clinical and imaging exams like X-ray, ultrasound, or ophthalmoscopy. They show how a predisposition actually manifests — usually only conclusive after 12–18 months.
We group breeding programs into three levels based on testing depth. Ask your breeder directly which level they meet.
A breeder at the Great level performs all mandatory tests plus 10 additional clinically recommended screenings that reduce risk in this breed.
In addition to mandatory tests:
Brachycephalic obstructive airway syndrome (BOAS)(BOAS)
Atmung
Brachycephalic obstructive airway syndrome (BOAS) is a severe respiratory condition affecting short-muzzled dog breeds, where the physical shortening of the skull leaves insufficient space for the upper airways. This structural compression forces tissues like the soft palate and nasal passages into a restricted area, significantly obstructing the flow of oxygen to the lungs. Over time, the increased effort required to breathe puts chronic strain on the dog's respiratory and cardiovascular systems.
Physical examination · Passing: clear
Ectropion / Entropion
Augen
These are structural eyelid abnormalities affecting a dog's eyes. In cases of entropion, the eyelid rolls inward, causing the eyelashes or fur to rub painfully against the surface of the eyeball. In ectropion, the eyelid sags or rolls outward, leaving the sensitive inner lining of the eye exposed and unprotected.
Passing: clear
Exposure keratopathy syndrome (exophthalmos, lagophthalmos, and/or macroblepharon)(EKS)
Augen
This condition involves chronic damage to the cornea, which is the clear protective outer layer of the eye. It occurs when the eyelids cannot fully close to moisten the eye, often due to protruding eyeballs, incomplete eyelid closure, or an abnormally large eyelid opening. Without proper moisture, the delicate surface of the eye becomes dry, inflamed, and vulnerable to injury.
Eye examination · Passing: clear
Complex vertebral malformation(CVM)
Bewegungsapparat
Complex vertebral malformation is a congenital condition where the bones of the spine, known as vertebrae, do not develop properly during fetal growth, sometimes resulting in abnormally shaped bones like "butterfly vertebrae." This structural defect affects the skeletal system and can put pressure on the spinal cord, which is the main nerve pathway running down the back.
X-ray
Atopy(CAD)
Haut und Fell
Atopy is a chronic allergic skin disease where a dog's immune system overreacts to common environmental substances like pollen, mold spores, and dust mites. This inappropriate immune response damages the natural protective barrier of the skin, leading to persistent inflammation and irritation. It primarily affects the skin, which is the body's largest organ system.
Skin test
Demodicosis / Demodectic mange
Haut und Fell
Demodicosis is a skin disease caused by an overgrowth of microscopic Demodex mites that naturally live inside a dog's hair follicles. While these mites are normally harmless, an inherited or acquired weakness in the immune system can allow them to multiply uncontrollably. This overgrowth leads to inflammation and damage to the skin barrier.
Skin test
Fold dermatitis/pyoderma
Haut und Fell
Fold dermatitis, also known as intertrigo, is an inflammatory skin condition that occurs within deep skin folds. When skin rubs against skin, it traps moisture, heat, and debris, creating an ideal environment for bacteria and yeast to overgrow. This leads to localized skin infections, particularly in breeds with pronounced facial, lip, or tail folds.
Physical examination
Sick sinus syndrome(SSS)
Herz
Sick sinus syndrome is a disorder of the heart's electrical system, specifically affecting the sinoatrial node, which acts as the heart's natural pacemaker. This malfunction causes the heart to beat too slowly, too quickly, or with long pauses, disrupting normal blood flow to the body. An echocardiogram (an ultrasound of the heart) is typically performed alongside electrical monitoring to rule out other structural heart diseases before proceeding with treatment.
Physical examination · Passing: normal
Meningitis(SRMA)
Nervensystem
Meningitis is a severe inflammatory condition affecting the protective membranes, called meninges, and blood vessels surrounding the brain and spinal cord. In dogs, this most commonly occurs as an immune-mediated disorder known as Steroid-Responsive Meningitis-Arteritis (SRMA). This means the dog's own immune system mistakenly triggers inflammation in these nervous system tissues without any actual infection being present.
Necrotising meningoencephalitis(NME)
Nervensystem
Necrotising meningoencephalitis is a severe, progressive inflammatory disease of the brain and its protective outer membranes, known as the meninges. It occurs when the dog's own immune system mistakenly attacks healthy nerve tissue, causing tissue death, or necrosis, in the brain. This condition primarily affects the central nervous system of certain small and toy dog breeds.
These levels are a comparison framework, not an official certification. They help compare breeding programs at a glance.
A complete checklist with every mandatory and recommended test plus identity and rearing questions — take it with you.
Open the full checklistFor breeders
Machine-readable mating rules, minimum ages, scoring schemes, and what's required for HonestDog verification — as a printable guide.
Example rule — Keratoconjunctivitis sicca (KCS) - "dry eye"
Both parents must be clear or better.
We compile mandatory tests from official breed regulations and veterinary databases — and cross-check every uploaded certificate against the dog's profile using AI.
L1 = mandatory under breed-club regulations. L2 = recommended or clinically indicated. L3 = lower prevalence. Every assignment carries a source and confidence rating.
VDH breeding regulations, CIDD (University of PEI), OMIA (University of Sydney), curated veterinary input.
Uploaded certificates are read by AI and checked for date, result, and consistency with the dog's profile — our team reviews anything inconclusive.
A strongly shortened muzzle is typical of the Pug and counts as an extreme-breeding trait: it can cause breathing difficulty (BOAS), heat problems and eye disease. That is why we currently do not show breeders for this breed. A dog of this breed can still have a good life – what matters is explained on our brachycephaly page.
Self-check
Answer 6 quick questions about your everyday life and see how well the Pug fits you — including an honest cost estimate per month, per year, and across the dog's lifetime.