Lung Disease and Lupus

Lungs are delicate organs that feed every organ of the body the oxygen that they need. So how does lupus impact your lungs?

Our lungs are vital organs that take in air and transfer the oxygen in the air into the bloodstream, where it feeds and powers every cell and organ in the body. The lungs also remove waste products like carbon dioxide and expel these waste products from the body. Unfortunately, the lungs are also very sensitive to both the environment and to our own health.  

It is common for people with systemic lupus erythematosus (SLE) to have problems with their lungs. Chronic respiratory issues, which restrict breathing and can happen at any point in SLE, both early at diagnosis, or later on as the disease progresses. It’s been estimated that 90% of people with lupus have problems with their lungs and breathing.  

Chronic respiratory and lung diseases can have serious symptoms including: 

• Fatigue and low stamina 

• Pain and discomfort 

• Sleep deprivation and chronic exhaustion 

• Lack of focus and unclear thinking 

• Shortness of breath and wheezing 

• Coughing and hacking 

• Fluid buildup in the lungs or extremities 

And, in certain circumstances, chronic respiratory disease can even be fatal. 

How do the Lungs Work? 

The lungs are sack-like, flexible organs in the chest that are connected to the outside world through the throat, and from there, through the nose and mouth. The left lung is slightly smaller than the right lung, to make room for the heart, which is located nearby. They, like the heart, are protected by the ribcage.  

The lungs themselves do not control ‘breathing.’ Instead, muscles outside of the lungs manage breathing. Breathing happens as the muscles of the chest wall, abdominal muscles, neck muscles, and diaphragm move, changing the pressure in the chest cavity. Because the rest of the body is sealed, and the lungs are connected to the outside, only the lungs are able to expand and contract. This allows the body to pull in new air and expel out old air. These expansions and contractions happen with every breath. However, this also means that deep injuries to the chest or abdomen can make breathing difficult, as it breaks this seal.  

Breathing is subconscious – the body does it automatically. However, these muscles can also be consciously controlled, which lets people breathe faster or slower at will, and even hold their breath. 

Healthy lungs can hold, on average, 6 liters of air though this varies from person to person, though the lungs do not use all of it in each breath.  

The lungs are not totally hollow. They are made up of flexible networks of bronchial tubes, which constantly branch off into clusters called alveoli. Blood vessels are woven around these alveoli, allowing oxygen to pass through the tissues of the alveoli into the blood, and carbon dioxide and other waste products to pass back into the lungs, where it is breathed out. The network of tubes gives the lungs a surface area that lets it use the air efficiently. However, the lungs are not fully filled with each breath, unless a person chooses to breathe particularly deeply.  

The lungs are coated with a mucous layer to keep the tissues from drying out and protect it from dirt, allergens, and bacteria from the outside world. This mucous is constantly being produced and pushed out of the lungs to keep the lungs clean and healthy. 

Sometimes, though, the lungs overproduce mucous and clog the airways. The lungs can also be affected by fluid retention, pulling fluids from the oversaturated blood stream and damaging the surrounding tissues. Because the oxygen that they provide is so vital, the lungs have an effect on every organ in the body, and, therefore, nearly every symptom of lupus. 

The Many Forms of Lung Disease and Lupus 

People with lupus can experience a wide range of lung-related symptoms, usually a combination of several at once.  

These include problems involving the lungs: 

• Shrinking Lung 

• Chronic obstructive pulmonary disease (COPD)  

• Emphysema  

• Pulmonary embolism 

The nose and throat (which carry air to the lungs): 

• Asthma 

• Skin lesions in the tissues of the nose, mouth, and throat (which can lead to pain, infection, and blockages.) 

The cardiovascular system:  

• Stroke and blood clots 

• Inflammation-related anemia  

• Heart Disease  

• Fluid retention causing swelling and bloating, particularly in the feet 

• Hypoxia, a condition where the body is not getting enough oxygen 

Cardiovascular issues are very common for people with lupus. You can read more about how lupus affects the heart and the bloodstream here. 

People with lupus are also much more likely to get respiratory infections for multiple reasons: Their immune systems are not working properly due to lupus, and the medication that treats lupus can suppress their immune systems and leave people less protected from bacteria, viruses, and fungi. Inflammation from lupus causes changes to the organs themselves that make them more vulnerable to infection (such as irritation, lower mucous or saliva production, or damage from inflammation.)  

COPD and Lupus 

COPD is any chronic obstruction to the lung that blocks proper airflow through the passages of the lungs. This can be due to damage, higher mucous production, swelling from inflammation, or any combination of these. COPD has many causes, but damage to the lungs, inflammation from lupus, and exposure to air pollutants are the common ones. Smoking is one of the leading causes, and vaping may also contribute to COPD. Although it can have a few different forms, it is well known that COPD is the sixth leading cause of death in the United States according to the CDC. 

People with lupus are vulnerable to developing COPD, and unfortunately, like lupus, there is no complete cure for COPD. However, lifestyle changes are one of the primary treatments, which can reduce the symptoms and slow the progress of COPD. If the COPD is particularly bad, oxygen therapy, medications, and other medical treatments may be needed. 

Pleurisy and Lupus 

Pleruisy is an inflammatory condition where the tissue lining the lungs becomes inflamed. Inflammation causes these delicate tissues to swell, become extra sensitive, and retain fluids. It can also cause direct damage to these tissues, making it harder for the lung to do its job.  

Pleurisy restricts the lung’s ability to take in air, process the oxygen into the blood stream, and clear out blockages by coughing. It is also extremely uncomfortable, causing chronic coughing, fever, and intense chest pain that worsens during deep breathing, coughing, or sneezing. Fortunately, because it is inflammatory, any treatment for lupus also directly treats pleurisy. Many lupuswarriors with pleurisy also use pain medications or other therapies to reduce the constant pain.  

Shrinking Lung and Lupus 

Shrinking lung syndrome is very dramatic sounding rare condition where the lungs reduce in size and volume. Chest X-rays can see it easily – shrinking lung shows up as abnormally small lungs, though there may not be anything wrong with them in terms of damage or structure. The causes are not fully known, but it’s possible that damage to the stretchiness of the lungs or a weakening of the diaphragm muscle, which helps the lungs pull in air, could be a part of it. The reduced lung volume means that the lungs rarely get enough air to completely support the body. This leads to shortness of breath, lower oxygen levels in the bloodstream, and chest pain.  

Shrinking lung syndrome happens in autoimmune diseases. People with systemic lupus erythematosus (SLE), Sjogren’s syndrome, and rheumatoid arthritis can all potentially develop this condition. 

Currently, lung capacity can’t be fully reversed, but is treated with corticosteroids, inhaled medications that relax the airways, and physiotherapy. People find that, in some cases, treatment does restore their some of their lung capacity. 

Testing for Lung Disease and Lupus 

There are a few tests to determine how functional your lungs are, and whether you need additional medical intervention: 

Pulse oximetry: Also known as a “pulse ox” this test measures the levels of oxygen presently being carried by your bloodstream 

Arterial Blood Gasses: This test looks at both oxygen and carbon dioxide in your bloodstream. 

Electrocardiogram: This test measures the electrical signals that trigger the heart to contract and pump regularly. This test checks heart function and helps to rule out heart disease. 

Chest Scan: Either an X-ray or a CT scan are imaging tests that look directly at the lungs and try to determine if there is damage. 

Exercise testing: This noninvasive test allows medical professionals to monitor your condition and blood oxygen levels during exercise to get a better picture of what is going on. 

Treating COPD, Lung Disease, and Lupus 

Although there is no cure for chronic lung diseases caused by lupus, it can be treated into temporary inactivity (a nearly symptom-free state known as remission) , or at least brought down to a tolerable level of pain and functionality. 

Anti-inflammatory medications such as corticosteroids will treat lung disease caused by inflammation. These are also commonly used to bring lupus under control, too, so people with lupus are typically already taking them. 

Vaccinations help prevent deadly diseases like the flu and pneumonia, which people with COPD are more vulnerable to. Antivirals or antibiotics might also be taken, and people with COPD often take additional measures to avoid infections, like frequent hand washing and sanitizing the environment. 

Bronchodilators, anticholinergics, and leukotriene modifiers are medications that relax the airways, which opens them up and can help bypass blockages.  

Supplemental oxygen can help increase your oxygen levels to a functional amount if your lungs are not able to take in and absorb enough for your body. 

Expectorants, which thins out mucous and makes it easier for your body to remove it.  

Diet can help some people keep their weight down, which reduces the strain on their respiratory system. A healthy, balanced diet is important for people with lupus, too.

There are also breathing exercises that can help with shortness of breath and make it possible to remain physically fit – which also helps with lung capacity and function. Masks are sometimes used to keep out dirt, pollutants, and pathogens, and can be beneficial for people with lupus. However, they restrict breathing, and people who already have restricted breathing may have trouble using them. 

Treating lung disease and lupus can be difficult, but the lungs have a huge effect on the body. Treating lung disease can improve a person’s ability to take care of themselves and their environment, get enough exercise, and feel better.