Two-Way Association Identified Between Psoriasis, Asthma

A bidirectional association has been identified between psoriasis and asthma with significantly increased risk, according to a systematic review and meta-analysis study is published in BMC Pulmonary Medicine.¹

While the risk of asthma in patients with psoriasis has been identified in previous studies, a bidirectional relationship has not been previously explored.

These findings suggest a need for clinician awareness of the connection between psoriasis and asthma, particularly for adolescents or patients with moderate to severe psoriasis who may be at greater risk of developing asthma.

“This study is the first to conclusively claim a bidirectional link between psoriasis and asthma, with the systematic review and meta-analysis summarizing all previous research on the topic,” wrote the researchers of the study. “Consequently, this paper proposes that while making a clinical diagnosis, it is essential to consider how psoriasis and asthma differ and interact.”

Psoriasis is a skin condition, but it has been associated with comorbidities such as respiratory disease, arthritis, cardiovascular disease, and depression.² While the risk of asthma in patients with psoriasis has been identified in previous studies, a bidirectional relationship has not been previously explored.

In this study, the researchers conducted a search through PubMed, Embase, and the Cochrane Library of observational studies published from inception to October 2023. The search included relevant studies of medical subject headings and synonyms for psoriasis and asthma with no geographic or language restrictions. All cohort studies, case-control studies, or cross-sectional studies describing the prevalence or risk factors for patients with psoriasis with asthma or patients with asthma with psoriasis were included.

A total of 3962 records identified in the databases were screened for eligibility. After excluding for duplicates and type of study, only 16 records were included for review.

The 16 studies included were conducted between 2011 and 2023, with more than 12 million participants. Patients with psoriasis had a higher risk of developing asthma (OR, 1.48; 95% CI, 1.28-1.68). Meanwhile, patients with asthma also had a higher overall risk of developing psoriasis (OR, 1.33; 95% CI, 1.23-1.44).

Additionally, the subgroup analysis revealed that type of study, age, and severity of psoriasis were significant factors for asthma risk in patients with psoriasis. For example, asthma susceptibility was higher in adolescents aged 18 years or younger (OR, 1.34; 95% CI, 1.11-1.62) compared with adults (OR, 1.30; 95% CI, 1.30-1.33). Similarly, patients with severe psoriasis (OR, 1.40; 95% CI, 1.24-1.60) were more susceptible to asthma than patients with mild and moderate psoriasis (OR, 1.23; 95% CI, 1.10-1.42).

However, the researchers acknowledged some limitations to the study. First, there was a high degree of heterogeneity and scarcity of studies on psoriasis in patients with asthma. Second, the researchers noted that recall bias may have factored into the study due to it being a cross-sectional and cohort study focusing on the risk of asthma in patients with psoriasis.

Despite these limitations, the researchers believe the study provided evidence of a bidirectional relationship between psoriasis and asthma.

“The risk of psoriasis in asthma and the risk of asthma in psoriasis are both significant, as shown in this systematic review and meta-analysis,” wrote the researchers. “Consequently, patients with asthma should pay attention to the timely identification of psoriatic lesions because, according to the research available at the moment, there are similarities between the two pathogenic mechanisms.”

References

1. Wu D, Zhou X, Wu F, et al. Association between psoriasis and asthma: a systematic review and bidirectional meta-analysis. BMC Pulm Med. 2024;24(1):293. Published 2024 Jun 24. doi:10.1186/s12890-024-03078-7

2. Kaltwasser, J. Asthma, airflow limitation linked with respiratory failure in psoriasis. July 26, 2023. Accessed June 27, 2024. https://www.ajmc.com/view/asthma-airflow-limitation-linked-with-respiratory-failure-in-psoriasis