From the Guidelines
Bronchitis in Sjögren's syndrome should be managed with a multidisciplinary approach, focusing on symptomatic relief, prevention of complications, and close monitoring of pulmonary function, as recommended by the consensus guidelines for evaluation and management of pulmonary disease in Sjögren's 1.
Key Considerations
- Patients with Sjögren's syndrome often develop chronic bronchitis due to reduced secretions, leading to thickened mucus and impaired clearance of airway irritants.
- Treatment typically involves managing both conditions simultaneously, with a focus on relieving symptoms and preventing complications.
- For acute bronchitis episodes, short courses of antibiotics like amoxicillin-clavulanate or azithromycin may be needed if bacterial infection is suspected, as suggested by the guidelines 1.
Management Strategies
- Inhaled bronchodilators such as albuterol can help relieve bronchospasm, while medications like pilocarpine or cevimeline can stimulate secretions to alleviate Sjögren's-related dryness.
- Mucolytics like guaifenesin may help thin mucus, and humidification can improve positive airway pressure tolerance and compliance, as recommended by the guidelines 1.
- Long-term management should include pulmonary function monitoring, as Sjögren's patients have an increased risk of developing interstitial lung disease, and preventive measures such as pneumococcal and annual influenza vaccinations are essential, as emphasized by the consensus guidelines 1.
Important Recommendations
- Smoking cessation is strongly recommended in all Sjögren's patients, as it can exacerbate pulmonary disease, according to the guidelines 1.
- A multidisciplinary approach, including a rheumatologist, primary care physician, pulmonologist, pathologist, radiologist, and oncologist, is necessary for the care of Sjögren's patients with suspected or confirmed pulmonary complications, as highlighted by the consensus guidelines 1.
From the Research
Bronchitis in Sjögren's Disease
- Bronchitis is a common manifestation of tracheobronchial disease in Sjögren's syndrome, characterized by diffuse lymphocytic infiltration of the airway 2.
- Tracheobronchial disease in Sjögren's syndrome can also present as bronchial hyperresponsiveness, bronchiectasis, bronchiolitis, or recurrent respiratory infections 2, 3.
- The management of bronchitis and other tracheobronchial manifestations in Sjögren's syndrome may require treatment for dryness and/or inflammation of the airways 2.
- Constrictive bronchiolitis is a rare extraglandular manifestation of primary Sjögren's syndrome, associated with an indolent clinical course and poor response to immunosuppressive therapy 4.
- Bronchiolitis can be a severe complication of Sjögren's syndrome, and its diagnosis is based on the integration of clinical, immunological, and histopathological criteria 5.
Pulmonary Involvement in Sjögren's Syndrome
- Pulmonary involvement is not a dominant feature of Sjögren's syndrome, but can be severe in some cases 3.
- The most common pulmonary manifestations of Sjögren's syndrome are interstitial lung disease (ILD) and tracheobronchial disease 2.
- ILD is a significant cause of death in Sjögren's syndrome, while tracheobronchial disease has little effect on respiratory function and is rarely the cause of death 2.
- Rare respiratory complications such as amyloidosis, lymphoma, or pulmonary hypertension should not be disregarded in Sjögren's syndrome patients 2, 3.
Treatment and Management
- Corticosteroid therapy is the mainstay of ILD treatment in Sjögren's syndrome, but the use of other immunosuppressive drugs needs to be determined 2.
- Treatment of Sjögren's disease should be tailored to the type and severity of organ involvement, ideally based on multidisciplinary evaluation 6.
- The management of bronchitis and other tracheobronchial manifestations in Sjögren's syndrome may require treatment for dryness and/or inflammation of the airways, as well as immunosuppressive therapy 2, 4.