Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues. Lupus can affect various organs, and the lungs are no exception. Coughing in individuals with lupus can arise from direct lupus-related lung inflammation or other common health issues. Understanding the potential causes of a cough is important for people living with this condition.
How Lupus Affects the Lungs to Cause Coughing
Lupus can directly impact the respiratory system through inflammatory processes, leading to various lung conditions that manifest as a cough. Pleurisy, also known as pleuritis, is a frequent lung complication in lupus patients, involving inflammation of the lining around the lungs. This inflammation can cause a sharp chest pain that worsens with deep breathing or coughing, and may involve fluid buildup around the lungs, known as pleural effusion.
Acute lupus pneumonitis involves inflammation of the lung tissue itself and can cause a persistent cough, sometimes productive, along with fever and difficulty breathing. This serious condition affects a small percentage of lupus patients, typically between 1% and 10%. Chronic interstitial lung disease (ILD) can also develop, which is characterized by long-term inflammation and scarring of lung tissue, leading to a persistent dry cough and progressive shortness of breath. ILD affects about 3-13% of SLE patients and can emerge several years after a lupus diagnosis.
Pulmonary hypertension, a serious complication of lupus, involves high blood pressure in the arteries leading to the lungs. While less common, affecting an estimated 0.5% to 17% of lupus patients, it can cause a cough, shortness of breath, and fatigue. Shrinking lung syndrome is a rare condition where the lungs appear smaller on imaging due to diaphragm weakness or pleural adhesions. This can lead to shortness of breath and a dry cough, impacting lung function.
Other Reasons for Coughing in People with Lupus
A cough in someone with lupus does not always indicate a lupus-related lung issue; common infections remain a frequent cause. Viral infections such as the common cold, flu, or bronchitis, and bacterial infections like pneumonia, can affect individuals with lupus, particularly since immunosuppressant medications can weaken the immune system.
Certain medications used to manage lupus or co-existing conditions can also induce a cough. For example, some blood pressure medications, specifically ACE inhibitors, are known to cause a dry cough as a side effect. Gastroesophageal Reflux Disease (GERD), where stomach acid flows back into the esophagus, is another common cause of chronic cough that can affect lupus patients. Acid irritation of the airways can trigger a cough, often worse at night or when lying down.
Pre-existing respiratory conditions like allergies or asthma can also lead to a cough. Allergies can cause a persistent cough, sometimes accompanied by wheezing and shortness of breath. Asthma, a chronic inflammatory condition of the airways, commonly presents with coughing, wheezing, and chest tightness. It is important to consider these more common causes before attributing a cough solely to lupus activity.
Diagnosing and Managing Lupus-Related Cough
When a cough in a lupus patient is suspected to be lupus-related, a thorough medical evaluation is essential to determine the underlying cause. This process typically begins with a detailed medical history and a physical examination to identify specific symptoms and their progression. Imaging tests are often employed, including chest X-rays to check for fluid around the lungs or other abnormalities, and high-resolution computed tomography (CT) scans for more detailed views of lung tissue. Pulmonary function tests (PFTs) measure how well the lungs are working, assessing lung volume and airflow, which can help detect early changes in lung function.
Blood tests are conducted to assess lupus disease activity and to rule out infectious causes that might present with similar symptoms. In some cases, more invasive procedures like bronchoscopy, which involves inserting a thin tube with a camera into the airways, or a lung biopsy may be necessary to obtain tissue samples for definitive diagnosis. These diagnostic steps help differentiate lupus-specific lung involvement from other conditions.
Management of a lupus-related cough primarily focuses on controlling the underlying lupus activity and inflammation. This often involves medications such as corticosteroids, like prednisone, which help reduce inflammation throughout the body. Immunosuppressants, including azathioprine, mycophenolate mofetil, or cyclophosphamide, may also be prescribed to suppress the overactive immune system.
Biologic medications represent a newer class of treatments that specifically target parts of the immune system involved in lupus. Symptomatic relief for the cough may involve cough suppressants. Additionally, lifestyle adjustments like avoiding smoking and staying hydrated can support overall lung health.
When to Seek Medical Attention
Individuals with lupus should be vigilant about new or worsening respiratory symptoms and consult their healthcare provider promptly. A new or persistent cough, especially if accompanied by shortness of breath or difficulty breathing, warrants medical evaluation. Chest pain, particularly if sharp or worsening with deep breaths, is another concerning symptom that requires immediate attention.
Other warning signs include fever or chills, which could indicate an infection, or coughing up blood or discolored sputum. Unexplained weight loss or fatigue that is significantly more severe than usual can also signal underlying health issues. Any cough that is persistent or significantly interferes with daily activities should prompt a discussion with a doctor to determine its cause and appropriate management.