Psoriasis and Respiratory Comorbidities: The Added Value of Fraction of Exhaled Nitric Oxide as a New Method to Detect, Evaluate, and Monitor Psoriatic Systemic Involvement and Therapeutic Efficacy

Abstract

Psoriasis is a chronic inflammatory systemic disease characterized by a wide range of comorbidities. Respiratory comorbidities are currently poorly characterized and with discordant results. The systemic state of inflammation caused by psoriasis acts de novo on respiratory tissues and amplifies preexisting inflammation from asthma or chronic obstructive pulmonary disease. Because the lungs act as a gas exchanger between the internal and external environment, the impact of chronic psoriasis inflammation may be easily assessed through the analysis of exhaled breath. The fraction of exhaled nitric oxide test (FeNO) is a potential noninvasive solution that can provide quantitative and qualitative indices of respiratory airway inflammation. FeNO is routinely used to screen and manage asthmatic patients. Recent pilot studies contain encouraging data that underscore its possible use with systemic inflammatory nonpulmonary diseases, such as psoriasis. FeNO may therefore be a useful tool to evaluate underestimated airway inflammation and at the same time globally evaluate the impact of systemically antipsoriatic therapies.

Biologics increase the risk of SARS ‐ CoV ‐2 infection and hospitalization, but not ICU admission and death: Real‐life data from a large cohort during red‐zone declaration

“…Moderate to severe psoriasis benefit from systemic treatment as biologics and small molecules; at the same time these drugs, capable to clear psoriasis, are related also to an increased risk of airway infections 2 . PsO patients also display a baseline airway inflammation that triggers the constellation of chronic respiratory comorbidities, such as asthma and chronic obstructive pulmonary disease (COPD) 3 . Furthermore, PsO patients are frequently smokers and cigarettes increased flares as well as psoriasis severity, predisposing to COPD and exacerbating asthma crisis 4 …”

From randomized clinical trials to real life data. An Italian clinical experience with ixekizumab and its management

“…Psoriasis is a systemic inflammatory disease characterized by a growing body of comorbidities; however availability of targeted anti‐psoriatic therapy has been largely limited (Al‐Mutairi, Al‐Farag, Al‐Mutairi, & Al‐Shiltawy, ; Asa'ad, Fiore, Alfieri, et al, ; Fiore, Leone, Maraolo, et al, ; Jiang, Hinchliffe, & Wu, ; Santus, Rizzi, Radovanovic, et al, ; Yadav, Singh, & Singh, ). More recently, clinicians have been able to better treat psoriasis due to the development of targeted therapy allowing for: (a) second‐step therapy in moderate to severe psoriasis, (b) treatment of moderate to severe psoriasis in patients which have contraindication for traditional systemic drugs and/or (c) treatment of mild psoriasis not responsive to topical treatments (Ighani et al, ).…”

When IL‐17 inhibitors fail: Real‐life evidence to switch from secukinumab to adalimumab or ustekinumab

“…Psoriasis is a chronic, systemic inflammatory disease affecting 0.5–11.4% of the population (Michalek, Loring, & John, ). An increasing body of evidences seem to suggest that psoriasis‐related comorbidities contributes to make challenging the choice of a systemic treatment, in particular dermatologists first should carefully screen relative and absolute contraindications (Damiani et al, 2018; Fiore, Leone, Maraolo, et al, ; Santus et al, ; Strober et al, ). Furthermore, dermatologists are currently driven by experience and contraindication in choosing a biological therapy because of the lack of information of the so called biological signature of the patients (Feldman, Burudpakdee, Gala, Nanavaty, & Mallya, ).…”