Pugs most commonly die from old age, cancer, and neurological disease. In the largest UK survey of pug deaths, old age accounted for 22% of reported deaths, followed by cancer at 11%, anesthesia-related complications at nearly 7%, and heart failure at nearly 7%. But those numbers only tell part of the story. Pugs face a unique set of breed-specific risks, particularly involving the brain and airways, that can shorten their lives well before the typical 13 to 15 year lifespan.
The Most Common Causes of Death
The fact that old age tops the list is actually good news. It means a significant portion of pugs live out a full life without being cut short by disease. Cancer, the second most common cause, mirrors patterns seen across many dog breeds and tends to appear in middle-aged and older dogs. Heart failure, responsible for about 7% of deaths, is also consistent with what vets see in other small breeds.
What stands out about pugs is the unusually high rate of anesthesia-related deaths, also at nearly 7%. This is directly tied to their flat-faced anatomy. Pugs have compressed airways that make sedation and intubation riskier than in longer-snouted breeds. Even routine surgeries carry elevated risk, which is something to discuss thoroughly with your vet before any procedure requiring general anesthesia.
Neurological Disease: A Breed-Specific Threat
Pugs have one of the highest rates of neurological death among all dog breeds. Two conditions in particular drive this: Pug Dog Encephalitis and a spinal condition called constrictive myelopathy.
Pug Dog Encephalitis (PDE) is a rapidly progressive brain inflammation that is almost always fatal. The median age of onset is around 18 months, though it can appear anytime between puppyhood and age six. Once neurological signs develop, survival is often measured in days to months. In one European study, nearly 88% of pugs with suspected PDE died or were euthanized. About 7% of European pugs carry two copies of the genetic risk variant linked to PDE, and over a third carry one copy. A DNA test from UC Davis can identify whether a pug carries this variant, which is especially useful information for breeders trying to reduce the condition’s prevalence.
Constrictive myelopathy is a degenerative spinal condition that causes progressive weakness in the hind legs, eventually leading to paralysis and loss of bladder or bowel control. Unlike PDE, this condition tends to appear in middle-aged pugs and progresses slowly. Surgery has not been shown to stop or reverse it. For many owners, the decision to euthanize comes when the dog loses the ability to walk or develops incontinence that can’t be managed. Pug rescue organizations report being overwhelmed by surrendered dogs with this condition, because the level of daily care required is substantial.
Breathing Problems and BOAS
Pugs are one of the breeds most affected by Brachycephalic Obstructive Airway Syndrome, or BOAS. Their shortened skulls compress the soft tissues of the throat and nasal passages, making every breath harder than it should be. The condition is progressive. Over time, the extra effort of pulling air through narrowed airways causes the throat tissues to swell and thicken, which narrows the airway further.
In most pugs, BOAS shows up as chronic snoring, noisy breathing, and exercise intolerance. But it can escalate to a respiratory crisis, especially in hot weather or during physical exertion, where the dog simply cannot get enough air. Corrective surgery can widen the nostrils and trim excess tissue in the throat, improving airflow significantly in many cases. However, if the condition has progressed to a point where the cartilage supporting the airway has collapsed (called laryngeal collapse), outcomes are much less favorable even with surgery. Swedish insurance data listed breathing problems as one of the top five causes of death or euthanasia in pugs.
How Age Shifts the Risk Profile
Young pugs face a very different set of threats than older ones. In puppies and young adults, the biggest dangers are trauma, gastrointestinal emergencies, infections, and PDE. As pugs move into middle age and beyond, the risk shifts dramatically toward cancer, neurological degeneration, and heart disease. This pattern holds across most dog breeds, but the neurological component is disproportionately large in pugs compared to other breeds.
Understanding this shift matters practically. For a young pug, the priority is preventing accidents, keeping up with vaccinations, and knowing the early signs of PDE (seizures, circling, vision loss, behavioral changes). For an older pug, the focus moves to monitoring for lumps, watching for hind-leg weakness, and managing the cumulative effects of BOAS.
Genetic Testing and Early Detection
Two DNA tests are specifically recommended for pugs. The first screens for susceptibility to Pug Dog Encephalitis. A pug that carries two copies of the risk variant has a significantly higher chance of developing the disease, though not all carriers will. The second test checks for Pyruvate Kinase Deficiency, a red blood cell disorder that causes chronic anemia and can shorten lifespan.
Neither test guarantees a specific outcome, but both give owners and breeders information that can shape decisions. If you’re buying a pug puppy, asking whether the parents have been tested for these variants is one of the most useful questions you can ask a breeder. For pugs already in your home, the PDE test in particular can help you and your vet interpret early neurological symptoms more quickly, which matters when the disease can progress in days.
Beyond genetic testing, regular veterinary exams become increasingly important as pugs age. Heart murmurs, early signs of spinal degeneration, and changes in breathing effort are all things a vet can catch before they become emergencies. Pugs that maintain a healthy weight also tend to fare better with BOAS, since extra body fat puts additional pressure on already compromised airways.