Asthma, Airflow Limitation Linked With Respiratory Failure in Psoriasis

Patients with psoriasis who also have certain pulmonary comorbidities are at a higher risk of respiratory failure, according to a new study.

The report, published in the Journal of International Medical Research, adds further depth to the scientific understanding of the so-called “skin-lung axis.”

Psoriasis is a skin condition, but it is also associated with several systemic manifestations, noted the study authors. People with psoriasis and comorbidities such as respiratory disease, arthritis, cardiovascular disease, and depression, can experience a lower quality of life and a greater economic burden, they noted.

“In terms of respiratory comorbidities, psoriasis has been found to be associated with an increased incidence of asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease,” the authors said.

To better understand the impact of respiratory comorbidities among people with psoriasis, the investigators used a population-based database to see which respiratory comorbidities were most closely associated with respiratory failure in people with psoriasis. They used the UK Biobank, a population-based cohort of 500,000 individuals in the United Kingdom who were aged 40 to 69 years when they enrolled. The recruitment period for the database was 2006 through 2010.

The authors of the new study chose to limit their analysis to Caucasian patients due to the relatively low prevalence of psoriasis among Black patients and the low number of Black enrollees in the biobank project.

Of the 472,782 patients remaining in the database, 3285 said they had a diagnosis of psoriasis. Patients with a psoriasis diagnosis were more likely to be older and male and to report having smoked at some point in their lives. They also tended to be heavier and have higher body mass indexes. Their pulmonary function, as measured by forced expiratory volume and forced vital capacity, was lower than participants without psoriasis.

Psoriasis was associated with a higher risk of several pulmonary comorbidities, including emphysema, bronchiectasis, and ILD. Looking at respiratory failure rates specifically, the authors found that people with psoriasis and asthma (odds ratio [OR], 3.07; 95% CI, 2.13-4.43; P < .001) and airflow limitation (OR, 2.87; 95% CI, 1.84-4.47; P < .001) had a greater risk of comorbid respiratory failure than people without psoriasis. Notably, the authors did not find a link between emphysema and bronchiectasis and respiratory failure in people with psoriasis.

The authors said several of the genetic risk loci associated with psoriasis have also been linked with respiratory diseases and that psoriasis has been linked with increased airway inflammation—although treatment of psoriasis can positively impact that inflammation.

“Common immunopathological links implicating a ‘skin-lung axis’ may underlie psoriasis and pulmonary comorbidities,” they said.

The authors said their findings, in line with previous research, suggest that people with psoriasis may be predisposed to respiratory failure, particularly if they have comorbid asthma and airflow limitation.

“Therefore, physicians need to be aware of these pulmonary comorbidities because they could impair the quality of life and survival of patients with psoriasis,” they concluded.

Reference

Tanimura K, Nouraie SM, Chandra D, Nyunoya T. Pulmonary comorbidities in psoriasis are associated with a high risk of respiratory failure. J Int Med Res. Published online June 20, 2023. doi:10.1177/03000605231182881