Asthma, Pleurisy, the Lungs, & Lupus

Asthma, a chronic inflammatory disorder of the airways & lungs, adds challenges to life with lupus.

But, asthma is not the only pulmonary concern. Symptoms like coughing, wheezing, and shortness-of-breath should not be ignored.

If you are experiencing chest pains or if breathing becomes very difficult, you should call emergency services immediately. Tell your doctor and lupus treatment team about less severe symptoms.

According to the Johns Hopkins Lupus Center, “about 50% of people with SLE will experience lung involvement.” For this reason, it can be important for a rheumatologist and a pulmonologist to work together. Dr. Robert Kaner from the Hospital for Special Surgery noted that, “patients with lupus can be among the most complicated patients that pulmonologists see,” because of the large number of processes associated with lupus.

Research into asthma & lupus

A study published in 2014 explored the connection between asthma and lupus. The researchers shared in the exposition that there may be “immunologic similarities between allergies and autoimmunity.” Some studies have shown connections between lupus and atopic disorders like asthma, rhinitis conjunctivitis, and dermatitis.

The goal of research was to expand the existing literature using a retrospective cohort study. These types of studies use large datasets, typically provided by a large insurer. For this study, the data came from the National Health Insurance (NHI) system of Taiwan. Taiwan has a single-pay program that serves 99% of the 23.74 million Taiwanese people.

Participants

13,072 People with lupus were included in the trial. All participants were part of a SLE-certified illness program in Taiwan that required a valid lupus diagnosis.

52,288 controls were matched to ensure similar age and sex ratios.

The average age at the start of the trial was 35 years old for both groups.

Females made up 87.9% of both groups.

The study lasted for 11 years, but patients were followed up with if during that time they had a new diagnosis of asthma.

Results

The researchers concluded that people with lupus (SLE) have a significantly higher chance of developing asthma when compared to healthy control participants. Even after adjusting for variation, Lupus Warriors were more than 2.5 times as likely to get asthma.

Additionally, there were differences at baseline (prior to the follow-up period). Asthma was 1% more prevalent among the cohort that had SLE. And, the lupus group had significantly greater incidence of the following co-morbid conditions:

• rhinitis
• chronic sinusitis
• gastroesophageal reflux disease
• obstructive sleep apnea

The researchers noted the potential issues with their study. Te NHI data used did not include information on smoking habits, which have been linked to the development of asthma. Nor did the researchers have access to body-mass index data, drug history data, or family history data — all of which may be risk factors.

Additional pulmonary concerns

Beyond asthma, there are 5 additional lung problems that may be present alongside lupus.

1. Pleuritis (Pleurisy)

Condition: Pleuritis is inflammation of membrane surrounding the lungs, known as the pleura.

Symptoms: Pain when taking deep breaths because of the inflammation putting pressure on the lungs.

Treatment: NSAIDs, steroids, and/or antimalarials all may help prevent and treat the condition.

2. Acute lupus pneumonitis

Condition: Acute lupus pneumonitis impacts anywhere from 1-10% of people with lupus and is very serious.

Symptoms: Chest pain, shortness-of-breath, and a dry cough that may bring up blood.

Treatment: Immediate treatment with high-dose steroids and/or immunosuppressants. Even with successful treatment, this may result in permanent scarring of the lung tissue.

3. Chronic (fibrotic) lupus pneumonitis

Condition: Similar to acute lupus pneumonitis, except that symptoms come on slowly over years. Because of the gradual onset, it is easy to miss these symptoms.

Symptoms: Chest pain, shortness-of-breath, and a dry cough that may bring up blood.

Treatment: Immediate treatment with high-dose steroids and/or immunosuppressants. Even with successful treatment, this may result in permanent scarring of the lung tissue.

4. Pulmonary hypertension

Condition: Pulmonary hypertension (high blood pressure) occurs in about 10% of people with lupus. The blood vessel between the heart and the lungs thickens, limiting the amount of blood that can pass through the vessel. The heart will pump faster to counteract this resistance, but the eventual result is a decrease in oxygen-rich blood getting to vital organs.

Symptoms: Shortness-of-breath, bluish color in the lips and skin (cyanosis), racing pulse, dizziness

Treatment: May respond to corticosteroids and immunosuppressants. But, if it is not due to lupus, other medications approved specifically for pulmonary hypertension, like vasodilators, will be used.

5. “Shrinking Lung” Syndrome

Condition: A rare but serious lupus complication. Lung volume decreases over time resulting in smaller lungs and difficulty breathing.

Symptoms: Shortness-of-breath (breathlessness) and reduced chest expansion when breathing

Treatment: May respond to corticosteroids and immunosuppressants

Battling pulmonary concerns

There are additional pulmonary concerns beyond these 5 pulmonary concerns including interstitial lung disease, upper respiratory tract infections, and a pulmonary hemorrhage. Always bring up any pain, shortness-of-breath, or other potentially lung-related issues with your treatment team.

Many times, non-invasive procedures can be used to help your doctor make a diagnosis or offer treatment options. These procedures include:

• chest x-rays;
• chest CT (computed tomography) scans;
• pulmonary function tests (PFTs); and
• 6-minute walk test

After all, the peace-of-mind that comes from staying on top of your health can help you breathe easy.