Chronic Inflammation as the Underlying Mechanism of the Development of Lung Diseases in Psoriasis: A Systematic Review

Abstract

Psoriasis is a systemic inflammatory disease caused by dysfunctional interactions between the innate and adaptive immune responses. The systemic inflammation in psoriasis may be associated with the development of comorbidities, including lung diseases. In this review, we aimed to provide a summary of the evidence regarding the prevalence of lung diseases in patients with psoriasis and the potential underlying mechanisms. Twenty-three articles published between March 2010 and June 2021 were selected from 195 initially identified records. The findings are discussed in terms of the prevalence of asthma, chronic obstructive pulmonary disease, interstitial lung disease, obstructive sleep apnea, pulmonary hypertension, and sarcoidosis in psoriasis. A higher prevalence of lung diseases in psoriasis has been confirmed in asthma, chronic obstructive pulmonary disease, obstructive sleep apnea, and pulmonary hypertension. These conditions are important as they are previously unrecognized causes of morbidity and mortality in psoriasis. The development of lung diseases in patients with psoriasis can be explained by several mechanisms, including common risk factors, shared immune and molecular characteristics associated with chronic inflammation, as well as other mechanisms. Understanding the prevalence of lung diseases in psoriasis and their underlying mechanisms can help implement appropriate preventative and therapeutic strategies to address respiratory diseases in patients with psoriasis.

Keywords: asthma; chronic obstructive pulmonary disease; interstitial lung disease; obstructive sleep apnea; psoriasis; pulmonary hypertension; sarcoidosis; systematic review.

Figure 1

Potential mechanisms for the risk of lung diseases in psoriasis.

Figure 2

Literature search and review methodology.

Figure 3

Literature selection process with subdivisions into selected lung diseases. Abbreviations: COPD, chronic obstructive pulmonary disease; OSA, obstructive sleep apnea; PAH, pulmonary atrial hypertension; ILD, interstitial lung disease.

Figure 4

Risk factors common to psoriasis and lung diseases. Abbreviations: CTD, connective tissue disorder; COPD, chronic obstructive pulmonary disease; IPF, idiopathic pulmonary fibrosis; PAH, pulmonary atrial hypertension; and OSA, obstructive sleep apnea [43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62].

Figure 5

Immunological similarities between psoriasis and lung diseases. Abbreviations: Th, T helper cell; IL, interleukin [89,90,91,92,93,94].

Figure 6

Potential abnormalities in the lungs of patients with psoriasis [94,101,102,103,111,112,117,118,120,121].