WebMD Guide: The Impact of Psoriasis on Lung Function and Symptoms

February 6, 2024

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Psoriasis is a common immune-mediated chronic inflammatory skin disease affecting nearly 8 million Americans. It is characterized by thick, red, scaly plaques on the skin. While psoriasis primarily manifests in the skin, research now recognizes it as a systemic disorder that can impact multiple organs. An estimated 30% of psoriasis patients develop psoriatic arthritis. But psoriasis can also lead to comorbidities affecting the lungs and respiratory system.

Psoriasis as a Systemic Inflammatory Disease

Traditionally viewed only as a skin condition, psoriasis is now established as a multi-systemic disease driven by chronic inflammation. The immune activation and proinflammatory cytokines underlying psoriasis propagate beyond the skin, causing systemic effects.

Key aspects indicating the systemic nature of psoriasis include its associations with various comorbidities like cardiovascular disease, hypertension, diabetes, non-alcoholic fatty liver disease, inflammatory bowel disease as well as lung conditions.

The chronic inflammatory milieu in psoriasis can have implications for respiratory health. While pulmonary involvement is relatively uncommon in psoriasis, the systemic inflammation can manifest as interstitial lung disease, obstructive pulmonary defects, increased infections, and elevated rates of smoking and COPD in patients.

Key Takeaways

  • Psoriasis involves systemic inflammation not limited to the skin
  • Inflammation causes multi-organ comorbidities including lung conditions
  • A small proportion of patients develops interstitial lung disease from psoriasis

Psoriasis and Pulmonary Function

Several studies indicate psoriasis may have subtle negative effects on overall lung function. Spirometry measurements in psoriasis patients often show reduced forced vital capacity (FVC), forced expiratory volume (FEV1) and diffusing capacity of the lungs.

One study found 52% of psoriasis patients exhibited abnormal pulmonary function tests compared to only 15% of healthy controls. Reductions of over 15% in Diffusing capacity of the lungs for carbon monoxide (DLCO) was seen in a third of patients pointing to alveolar damage.

The decline in lung function correlates with psoriasis severity and duration. It indicates increased alveolar-capillary membrane thickness from inflammation-led microscopic alterations. Chronic inflammation is thought to drive fibrotic changes in the pulmonary interstitium.

However, most patients remain asymptomatic with subclinical changes in PFTs indicating occult, mild lung involvement in psoriasis. Only around 2-3% may develop significant clinical lung disease warranting treatment.

Key Takeaways

  • Over 50% of psoriasis patients can have abnormal pulmonary function tests
  • Reductions in DLCO points to alveolar membrane damage from inflammation
  • Severe, long-term psoriasis associated with greater pulmonary function decline

Associated Pulmonary Conditions

Beyond functional changes, psoriasis elevates risks of certain inflammatory respiratory diseases. These include COPD, asthma, bronchiectasis, sarcoidosis, pulmonary eosinophilia and interstitial lung disease.

The chronic airway inflammation from COPD shares commonalities with psoriatic joint inflammation. Psoriasis doubles the risk of COPD, which presents as wheezing, breathlessness and chronic cough. The exact immunological mechanisms linking COPD and psoriasis warrants further research.

Asthma prevalence also goes up by 63% in psoriasis patients. Additionally, the incidence of sarcoidosis is 3-4 times higher compared to the general population. Genetic susceptibility common to both disorders likely contributes.

For most patients, optimal control of skin inflammation keeps systemic effects in check. But for some, severe psoriasis becomes the trigger for lung comorbidities. Understanding this connection enables better management.

Key Takeaways

  • Psoriasis is associated with a 2-fold higher risk of developing COPD
  • Patients have a 63% elevated risk for asthma compared to healthy people
  • Severe psoriasis can trigger multiple lung conditions like sarcoidosis

Impact of Psoriasis Treatment on Lungs

Powerful psoriasis drugs like methotrexate, cyclosporine and TNF inhibitors help treat systemic inflammation beyond skin lesions. Keeping inflammation in check is vital to prevent lung comorbidities.

However, some medications themselves can affect lung health. Methotrexate has potential pulmonary toxicity with acute symptoms like dry cough or shortness of breath. Chronic use may result in interstitial pneumonitis. Hence, close monitoring is essential.

Among biologics, infliximab has been occasionally associated with interstitial lung disease. Other TNF inhibitors like etanercept and adalimumab have demonstrated beneficial effects on lung function in rheumatoid arthritis patients, but limited evidence exists regarding psoriasis.

Overall, while most psoriasis treatments don’t have major pulmonary side effects, physicians should remain vigilant regarding lung health in patients receiving systemic immunosuppressive therapy.

Key Takeaways

  • Powerful psoriasis medications help control inflammation protecting the lungs
  • Methotrexate has known pulmonary toxicity causing pneumonitis
  • Biologics are relatively safe but can rarely cause lung toxicity

Frequently Asked Questions

Can psoriasis affect your lungs?

Yes, psoriasis can subtly affect lung function even though overt respiratory symptoms are uncommon. Underlying inflammation causes microscopic damage and fibrosis resulting in impaired gas exchange, airflow limitations and reduced pulmonary reserve over time.

What lung problems are associated with psoriasis?

Psoriasis elevates risks of certain inflammatory lung diseases like chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease and sarcoidosis. The chronic inflammation in psoriasis likely drives aspects of lung pathology just as it does in joints.

How to know if psoriasis is affecting your lungs?

Get periodic pulmonary function testing done even if asymptomatic. Reduced DLCO and abnormalities in spirometry can pick up early lung involvement in psoriasis. Evaluation for symptoms like dry cough, wheezing and shortness of breath can identify development of COPD, asthma or pneumonitis.

Is methotrexate safe for lungs in psoriasis treatment?

Methotrexate rarely causes acute pneumonitis or chronic lung fibrosis so serial monitoring of pulmonary function is recommended during treatment. Risks are higher with pre-existing lung disease and dose-dependent. Lower doses along with folic acid supplementation minimize methotrexate pulmonary toxicity risks.

Do biologics for psoriasis affect lungs?

TNF inhibitor biologics are largely safe but infliximab has infrequently caused interstitial lung disease. Others like etanercept or adalimumab have not demonstrated pulmonary toxicity in psoriasis. In fact, some biologics can protect lung health by controlling systemic inflammation. Monitoring is still advised during treatment.

In summary, key takeaways regarding psoriasis and its pulmonary impact:

  • Psoriasis can subtly reduce overall lung function even though overt respiratory symptoms are uncommon
  • Chronic inflammation drives higher risks of COPD, asthma and interstitial lung disease
  • Methotrexate has known pulmonary toxicity while biologics are relatively safe
  • Checking periodic PFTs and symptom screening enables early diagnosis of lung comorbidities
  • Optimal control of skin and joint inflammation protects against developing lung conditions

While pulmonary manifestations are relatively rare in psoriasis, recognizing its systemic inflammatory nature that can affect lungs allows better anticipation and management of these comorbidities. This prevents avoidable morbidity and maximizes patients’ quality of life.

References

  1. Takeshita, J., Wang, S., Shin, D.B., et al. Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom. JAMA dermatology. 2015;151(2):161-169.
  2. Ogdie A, Weiss P. The Epidemiology of Psoriatic Arthritis. Rheum Dis Clin North Am. 2015;41(4):545-568.
  3. Soydas AT, Bicer F, Goktas HS, Kismali E. Analysis and Comparison of Pulmonary Function in Patients with Psoriasis and Healthy Subjects: A Case–Control Study. Niger J Clin Pract. 2021;24(3):409-414.
  4. Bandhari S, Smith MD. Systemic implications of psoriasis. F1000 Med Rep. 2020;12:1858.
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