Although uncommon, some people with Axial spondyloarthritis (axSpA) can develop lung problems.   

How can axSpA affect the lungs?

Some of the ways that axSpA can affect your lungs are described, below:

• Enthesitis is a condition causing inflammation at the sites where tendons or ligaments insert into the bone . This can occur in the ribcage or breastbone in people with axSpA. The stiffening of the chest can make it hard to fully expand your lungs. This can cause chest pain and shortness of breath. 
• Over time, inflammation can cause scarring in the lungs. This is a condition known as pulmonary fibrosis that can cause coughing, shortness of breath and chest pain. 
• People with axSpA are at higher risk of developing sleep apnoea compared to the general population . This is a condition where breathing stops and starts while you sleep. The link between axSpA and sleep apnoea is not clear. It is believed to be a result of chronic inflammation. 
• Spontaneous Pneumothorax is when a lung collapses suddenly without any cause.  

Symptoms 

Signs of lung problems include:

• Shortness of breath
• Cough
• Chest pain and/or tightness
• Rapid heart rate

Symptoms of sleep apnoea include

•  Snoring
•  Tiredness during the day
• Headache in the morning 
• Insomnia
• Stopping and starting of breathing during sleep (reported by another person). 

Diagnosis and treatment

Your doctor will look for any problems with your lungs using high-resolution computed tomography (HRCT). The HRCT scan may be used along with a physical examination and other tests to measure lung capacity to help diagnose you with lung disease.

  
There is no treatment to reverse lung damage. If you have sleep apnoea, there are devices like continuous positive airway pressure (CPAP) to help you breathe while you sleep. 

A class of medications called biologics are used to treat axSpA. Biologics help to reduce inflammation by blocking specific substances in the immune system. Biologics help to slow disease progression. However, it is unclear whether these types of medications have any effect on reducing the risk of lung complications. 
 

How common is lung problems in people with axSpA

Lung problems in people with axSpA is uncommon. Studies have estimated between 1-30% of people with axSpA have lung problems  . It is thought that the risk of lung problems increases with the duration of axSpA. 

Why does axSpA increases your risk of lung disease?

It is believed that the inflammation associated with axSpA can increase the risk of lung complications. Another reason is the fusing of bones between the spine and ribcage or breastbone. This can restrict the chest and make it difficult for the lungs to expand fully. 

Ways to help lower your risk

You can help lower your risk of developing lung problems by:

• Not smoking. Smoking causes inflammation, destroys lung tissue and is a major cause of lung cancer. If you smoke, try to quit. It may take a few tries, but quitting will benefit your arthritis and your overall health. You can call the Quitline on 13 78 48 for support and further information. 
• Avoiding exposure to outdoor air pollution. The main sources are from traffic, fires, and industrial facilities. It is hard to avoid outdoor air pollution but having a better understanding of how it can affect your health and how you can help protect yourself is a good way to start.  Go to: https://lungfoundation.com.au/lung-health/protecting-your-lungs/indoor-outdoor-air-quality/ for more information.
• Minimising indoor air pollution. Try to avoid using harsh chemicals in your home. If someone in your household smokes, ask them to smoke outside to avoid second hand smoke. 
• Preventing infection. A cold or flu can become serious. Help protect yourself by washing your hands, avoid large groups during cold and flu season, and get vaccinated. 
• Keep moving. Being physically active can help keep your lungs healthy and will benefit your arthritis too.  

This resources has been developed based on the best available evidence. A full list of resources is available on request