Take My Breath Away… Lupus and the Lungs
Lung Inflammation and Lupus
It is believed that 50% of SLE patients will experience (at some point) lung involvement woven into the tapestry of their disease. So without further ado, let’s declare the winner of the obnoxious “Overachiever Award” for attacking EVERYTHING goes to…drum roll…LUPUS! Well, isn’t that special. Not only can you not move due to pain, not think straight due to brain fog, not swallow due to Sjogren’s… but, now you can’t breathe either. Go ahead and stick another feather in your lupus cap – if you can find the room. Lupus inflammation can affect the lungs in many ways. It can attack the membrane lining of the lungs, the blood vessels in the lungs, the lungs themselves, and even the diaphragm. Typically, there are five lung issues that can occur with SLE: pleuritis, acute lupus pneumonitis, chronic lupus pneumonitis, pulmonary hypertension and “shrinking lung” syndrome. However, before you drop your mouse and call the first responders, let me say that most of these are very rare and treatable. So what exactly are all these seemingly complicated and hard to pronounce lung conditions? And why do lupus patients get them? Let’s break it down, one shallow breath at a time. Back to top
Or commonly known as “pleurisy” is inflammation (swelling) in the lining of the two-layered membrane (the pleura) of the lung. The inflammation can cause pain when breathing because of the pressure from the swelling. If fluid escapes the pleura, it is called “pleural effusion.” Pleurisy used to be very common as a secondary condition of bacterial infections, like pneumonia. But, since the introduction of antibiotics it has decreased significantly. Some cases can be so mild that people don’t even know they have it and the symptoms resolve on their own. However, if you are diagnosed with it, pleuritis may be treated with nonsteroidal anti-inflammatory (NSAIDS) medications (like Aspirin or Ibuprofen) and most people are suggested to take plaquenil (hydroxychloroquine) or other antimalarials to help thwart getting the condition altogether. Back to top
Acute Lupus Pneumonitis
No wonder you are out of breath. Saying that title alone is enough to make one gasp for air. Alright, this one is a doozy. This is a very serious condition classified by a dry cough (sometimes bloody), shortness of breath, and chest pain. Thankfully, acute lupus pneumonitis is a condition that only affects 1-10% of lupus sufferers. If you suspect you have this condition, seek medical attention immediately. Treatment for this includes: high dose steroids and usually immunosuppressant medications. Here is the silver “lung” lining – with proper diagnosis and treatment, scarring may be prevented. Back to top
Chronic Lupus Pneumonitis
This condition is the nasty, annoying relative of acute lupus pneumonitis that comes to stay at your house and never leaves. The difference between the acute and chronic versions of pneumonitis is that the acute comes on rather quickly, while the chronic pneumonitis can accumulate over years. The tricky part of this version is that often it takes so long to develop that most people don’t reach out to their doctor until after they have had it for some time. And while the inflammation caused by chronic lupus pneumonitis can be treated with steroids, the scarring that occurs usually is permanent. Back to top
I usually carry my tension in my neck, I had no idea I could carry it my lungs! All joking aside, this form of hypertension (high blood pressure) is a unique type in which the blood vessel that carries blood from the heart to the lungs thickens and doesn’t allow the appropriate amount of blood flow. The heart has to work harder to pump blood faster and quicker and that can put strain on it. When it cannot keep up with the demand, the rest of the body can suffer because it is not receiving the needed amount of oxygen. Thankfully, this condition only occurs in about 10% of lupus individuals. Unfortunately, rarely does it respond to steroids and immunosuppressant drugs. However, there are FDA approved medications for pulmonary hypertension like Flovan, Remodulin, Tracleer, and Revatio that are successfully being used. Back to top
Shrinking Lung Syndrome
I don’t know about you, but I would much rather have a condition called “shrinking butt” syndrome. Thankfully, shrinking lung syndrome is very rare with lupus sufferers. It is classified by unexplained labored breathing, a restrictive pattern on pulmonary function tests, and an elevated hemidiaphragm. Usually, it responds well to corticosteroid and immunosuppressive medications. Back to top
The moral of the story is, if you are having issues with shortness of breath, pain when breathing or have a strange cough…get medical help, ASAP. If you have SLE, don’t wait and assume it will go away. Don’t suffer in silence, see your doctor and take care of it! Always better to be safe than scarry! Back to top
Author: Kelli Roseta
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