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Asthma and Spondylitis: Is There a Connection?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A. — Written by Heather Lander, Ph.D.
Posted on October 18, 2021

Causes and Risk Factors | Living With Asthma and Spondylitis | Treatment | Management | Get Support

Spondylitis is a family of autoimmune diseases that cause chronic inflammation of the spine, neck, and hips. Research has found that ankylosing spondylitis (AS), in particular, is associated with asthma — a lung disease that causes chronic inflammation in the airways. Asthma can cause difficulty breathing and shortness of breath, among other symptoms.

Causes and Risk Factors of Asthma in Spondylitis

Evidence indicates that people with ankylosing spondylitis have an increased risk of allergy-related diseases, including asthma. One study, in particular, found that the incidence (rate of occurrence) of asthma was 1.74 times higher in people with ankylosing spondylitis than the general population (people without AS).

Similar to spondylitis, allergic diseases like asthma result from an inappropriate or exaggerated immune system response. This response often involves immune cells known as T cells — in the case of asthma, the helper T cells known as Th2 and Th17. The levels of these helper T cells have also been found to be elevated in people with ankylosing spondylitis.

The reason for the increased risk of asthma in AS is thought to be due to the increased levels of Th2 and Th17 cells found in AS. These helper T cells release cytokines — substances that signal to other cells to modulate (modify) the body’s immune response. If the helper T cells found in AS release these cytokines inappropriately, the T cells may cause asthma.

Some studies have found that having asthma increases the risk of developing the inflammatory form of arthritis called rheumatoid arthritis, and others show decreased risk. Further study into this connection is needed. AS is also a rheumatic disease, so research gathered from such studies may reveal similar findings for AS.

Living With Asthma and Spondylitis

Living with AS is already difficult, and adding asthma to the mix can make it more challenging.

Part of managing the pain and stiffness caused by AS involves getting regular physical activity. However, asthma can cause difficulty breathing and shortness of breath. These issues can make it more difficult to get the exercise needed to help manage AS symptoms.

MySpondylitisTeam members have described the difficulties they’ve experienced living with asthma and AS. “Along with the back issues,” wrote one member, “I’m having breathing issues. I was diagnosed three years ago with asthma, but in January, my asthma meds weren’t working anymore.” Another member shared their experience: “My back is hurting, and I can’t get comfortable. I’ve been fighting with asthma big time. I have to go to a lung specialist.”

Some members find that their asthma and spondylitis symptoms worsen alongside each other: “My asthma, axSpA [axial spondyloarthritis], and PsA [psoriatic arthritis] are flaring up,” shared one member. Another member wrote that the “inflammation from AS is causing pulmonary [lung] issues not related to asthma.”

One member wrote that their doctor believed the progression of their AS was contributing to their asthma symptoms: “I just saw my pulmonary doc last week, and he told me I have new scarring on my lungs (in the back) that I didn’t have just two months ago, and he considers that it’s from my AS … he did all the necessary tests and found the scarring. It’s because my AS is progressing rapidly.”

Treatments for Asthma With Spondylitis

Some asthma treatments are aimed at managing symptoms in the short term, and others aim to reduce inflammation, thereby decreasing disease activity in the long run. Talk to your doctor about what drugs or treatments for asthma are best for you. Your doctor may also refer you to a pulmonologist (lung specialist) to help treat and manage your asthma.

Inhaled Medications

In many cases, inhalers — devices that administer medication to be inhaled directly into the lungs — are prescribed to keep the airways open and make breathing with asthma easier. Inhaled asthma medications may contain corticosteroids (medications that quickly reduce inflammation and are for short-term use) or a combination of corticosteroids and a drug known as a beta-agonist.

Oral Medications

Some medications for asthma can be taken orally (by mouth). These drugs include theophylline and leukotriene modifiers, such as Singulair (montelukast) or Zyflo (zileuton).

Biologic Drugs

Biologics are genetically engineered proteins derived from living organisms. These drugs work by targeting specific components in the immune system that drive inflammation, including tumor necrosis factor alpha (TNF-alpha).

Some anti-rheumatic biologics used to treat AS, such as TNF-alpha inhibitors (anti-TNF), can alter levels of T cells to reduce inflammation and ease asthma symptoms. According to one study, a particular type of biologic (known as a humanized anti-IgE monoclonal antibody) allowed participants with asthma to decrease or stop their use of corticosteroids to control their symptoms.

Managing Asthma With Spondylitis

There are several ways you can manage your asthma symptoms while living with AS. The Mayo Clinic urges people with asthma to:

  • Track their symptoms carefully and thoroughly
  • Check lung function regularly
  • Follow up with their doctors to adjust medications as needed

The Canadian Lung Association provides the following helpful strategies for managing asthma.

Identify Your Asthma Triggers

Many different factors and substances can trigger asthma symptoms, such as:

  • Dust
  • Air pollutants
  • Tobacco smoke
  • Household cleaners

Identifying what situations or substances make your asthma symptoms worse can help you take care to avoid them and control your symptoms better.

Avoid Cigarette Smoke

Tobacco smoke is especially harmful to people living with asthma. If you don’t smoke, don’t start. If you do smoke, talk to your health care provider about setting a plan to quit. Make sure to avoid secondhand smoke, both indoors and outside.

Stay Physically Active

Regular exercise is important for managing both asthma and AS, so try to find ways to fit exercise into your daily routine. It is also important to allow yourself plenty of time to take breaks and rest. Finding an activity you enjoy can be particularly helpful — if you like gardening, for example, spending even 30 minutes each day raking the yard or pulling weeds can help get you moving more regularly.

Try some guided stretching and exercises for joint pain with Dr. Iris Navarro-Millán.

Practice Breathing Exercises

Deep breathing exercises can also be beneficial for both asthma and AS symptoms. Practicing breathing exercises on a regular basis may help stave off chest stiffness caused by AS and increase oxygen levels with pulmonary conditions such as asthma and chronic obstructive pulmonary disease. You can try these breathing exercises recommended by the American Lung Association. A pulmonary rehabilitation specialist can also give you exercises.

Learn how ankylosing spondylitis affects your heart.

Meet Your Team

Living with AS or caring for someone with spondylitis can be hard, but you don’t have to go it alone. Find support at MySpondylitisTeam — the social network for people living with spondylitis. More than 71,000 members gather to ask questions, give advice, and share their experience with others who understand life with spondylitis.

Are you living with spondylitis and asthma? Do you have any tips to help others? Share your experiences in the comments below or by posting on MySpondylitisTeam.

  1. About the Disease — Spondylitis Association of America
  2. Increase Risk of Allergic Diseases in Patients With Ankylosing Spondylitis — Medicine
  3. Asthma — Mayo Clinic
  4. The Risk of Asthma in Patients With Ankylosing Spondylitis: A Population-Based Cohort Study — PLoS One
  5. T Cells in Asthma: Influences of Genetics, Environment, and T-Cell Plasticity — The Journal of Allergy and Clinical Immunology
  6. Adaptive Immunity in Ankylosing Spondylitis: Phenotype and Functional Alterations of T-Cells Before and During Infliximab Therapy — Clinical and Developmental Immunology
  7. Historical Review of Cytokines — European Journal of Immunology
  8. Asthma and the Risk of Rheumatoid Arthritis: An Insight Into the Heterogeneity and Phenotypes of Asthma — Tuberculosis & Respiratory Diseases
  9. Ankylosing Spondylitis: Exercising Safely — Mayo Clinic
  10. Biologic Therapies: What and When? — Journal of Clinical Pathology
  11. Anti-TNF Therapy in Spondyloarthritis and Related Diseases, Impact on the Immune System and Prediction of Treatment Responses — Frontiers in Immunology
  12. Asthma Treatment: 3 Steps to Better Asthma Control — Mayo Clinic
  13. 7 Tips To Keep Your Asthma Under Control — Canadian Lung Association
  14. Asthma — Triggers — Centers for Disease Control and Prevention
  15. Being Active With Asthma — American Lung Association
  16. Exercise — Spondylitis Association of America
  17. The Efficiency of Inspiratory Muscle Training in Patients With Ankylosing Spondylitis — Rheumatology International
  18. Breathing Exercises — American Lung Association
Posted on October 18, 2021
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Heather Lander, Ph.D. is a virologist-turned-storyteller who writes about science to help researchers get funded and to help the rest of us understand what the researchers are doing. Learn more about her here.

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