When we think of Sjögren’s disease, dry eyes and dry mouth are often the first symptoms that come to mind. However, Sjögren’s is a systemic autoimmune disease, meaning that it can affect parts of the body beyond the glands responsible for producing tears and saliva. One important area that deserves greater awareness is the respiratory tract.
From the nose and throat to the airways and lungs, Sjögren’s can cause a range of symptoms and, in some cases, more significant respiratory complications. Understanding these potential effects can help patients recognize changes, communicate with their healthcare team, and seek appropriate assessment and treatment.
How Does Sjögren’s Affect the Respiratory Tract?
The respiratory tract relies on a healthy layer of mucus to keep its surfaces moist, trap inhaled particles, and help clear irritants and microorganisms. In Sjögren’s, reduced moisture production can interfere with these protective functions.
The effects may begin in the nose, where dryness of the mucous membranes can lead to a condition called atrophic rhinitis. As the airways continue toward the throat and lungs, inflammation may affect the larynx (voice box), trachea (windpipe), and bronchi (the larger airways that carry air into the lungs).
Inflammation of the trachea and bronchi, sometimes described as tracheobronchitis, may contribute to symptoms such as:
- Persistent or dry cough
- Hoarseness or voice changes
- Wheezing
- Shortness of breath
- Difficulty clearing mucus and inhaled particles from the airways
Because reduced mucus production can impair the airways’ natural cleaning mechanisms, some people may also be more susceptible to respiratory infections. Thick or poorly cleared secretions can sometimes obstruct smaller airways, potentially contributing to complications such as atelectasis, in which part of the lung collapses.
These symptoms should not automatically be attributed to Sjögren’s. Asthma, allergies, infections, medication effects, and other conditions can produce similar problems and may need to be investigated.
When Sjögren’s Affects the Lungs
Although airway dryness and inflammation can be troublesome, Sjögren’s may also affect the lung tissue itself. One important complication is interstitial lung disease (ILD).
ILD refers to a group of conditions involving inflammation or scarring of the tissue surrounding the lung’s tiny air sacs, called alveoli. These air sacs are essential for transferring oxygen into the bloodstream. When the surrounding tissue becomes inflamed or scarred, this exchange can become less efficient.
Symptoms vary from person to person. In the early stages, some people may have no noticeable symptoms. Others may experience a persistent dry cough or mild shortness of breath during physical activity. More advanced disease can cause significant breathlessness and limitations in everyday activities.
A chest X-ray may show abnormalities, but it can also appear normal in some cases. Depending on the symptoms and clinical findings, further assessment may include pulmonary function tests, which measure how well the lungs work, and high-resolution computed tomography (HRCT), which provides more detailed images of lung tissue.
In selected cases, a respiratory specialist may recommend a bronchoscopy or a lung biopsy to help clarify the diagnosis. These procedures are not necessary for everyone; investigations depend on the individual clinical situation.
Other Respiratory Complications to Know About
Sjögren’s can be associated with several other conditions involving the lungs and surrounding structures.
Bronchiectasis: Damage and widening of the airways can interfere with mucus clearance, sometimes leading to recurrent infections and a persistent productive cough.
Pleurisy and pleural effusion: Inflammation of the pleura, the membrane surrounding the lungs, can cause pain with breathing. In some cases, fluid may collect in the space between the layers of this membrane, contributing to shortness of breath.
Pulmonary hypertension: This condition involves increased blood pressure in the arteries that carry blood from the heart to the lungs. It may cause breathlessness, particularly during exertion, and requires appropriate medical investigation.
These complications do not develop in everyone with Sjögren’s. Their likelihood and severity vary, and some respiratory symptoms may arise from causes unrelated to the disease.
Diagnosis and Treatment: Why Individual Assessment Matters
There is no single treatment for all respiratory manifestations of Sjögren’s. Management depends on the underlying problem, its severity, and the person’s overall health.
For some people, supportive measures such as improving indoor humidity may help ease dryness and irritation. Prescribed inhaled treatments or nebulized saline may be considered in appropriate circumstances. Treatments that reduce airway inflammation or help clear mucus may also be useful for selected patients.
When ILD or another inflammatory lung complication is present, a specialist may recommend corticosteroids or other immunosuppressive treatments. More advanced conditions, such as pulmonary hypertension, require specific assessment and management.
Treatment decisions should always be made with a qualified healthcare professional. Not every cough requires immunosuppressive therapy, and not every person with Sjögren’s needs extensive lung testing.
A healthcare team may include a rheumatologist, pulmonologist (lung specialist), and primary care clinician. Regular follow-up is particularly important when respiratory symptoms persist, change, or interfere with daily activities.
Listening to Your Lungs: When to Seek Help
Living with Sjögren’s often means becoming familiar with symptoms that fluctuate over time. However, a new or persistent cough, unexplained breathlessness, wheezing, recurrent chest infections, or a noticeable reduction in exercise tolerance deserves attention.
Seek prompt medical assessment for new or worsening respiratory symptoms. Severe or sudden difficulty breathing, significant chest pain, or blue or grey discoloration of the lips warrants emergency medical care.
Keeping a record of symptoms, their duration, possible triggers, and their effect on daily activities can help healthcare professionals determine whether further investigation is needed.
The Takeaway
Pay attention to persistent respiratory symptoms, discuss concerns with your healthcare team, and maintain regular follow-up appropriate to your circumstances. Protecting respiratory health is an important part of caring for the whole person living with Sjögren’s.
Source: Adapted from chapter 14, “The Internal Organs in Sjögren’s,” by R. Hal Scofield, Fotini C. Soliotis, Stuart S. Kassan, and Haralampos M. Moutsopoulos, in The Sjögren’s Book, edited by Daniel J. Wallace, Oxford University Press, 2022, pp. 122–125. DOI: 10.1093/oso/9780197502112.003.0014.
This article is intended for general education and awareness. It does not replace individualized medical advice, diagnosis, or treatment.
