Respirology | APSR Respiratory Medicine Journal

What Is Chronic Lung Disease, The Condition Pope Francis Suffers From?

In just a matter of weeks, Pope Francis has faced several new challenges in his long-running battle with chronic lung disease. The spiritual leader's condition has been critical, with news of his well-being waxing and waning since Feb. 14 given his age and fragility.

Here's a breakdown of what 88-year-old Francis is facing:

What conditions does Pope Francis have?

As of Tuesday afternoon, Francis was in critical but stable condition at Rome's Gemelli hospital, where he had already spent nearly a dozen days in treatment. The Argentine pope was battling double pneumonia, as only his latest bout with lung infection.

He already suffered from preexisting chronic lung disease. As a young man, a portion of one of his lungs was ultimately removed after a severe respiratory infection.

ExplorePope Francis shows slight improvement and resumes some work, while still critical, Vatican says

Francis initially entered the hospital following a weeklong bout with chronic bronchitis. The double pneumonia diagnosis quickly followed. By the end of his first week of treatment, he was facing double pneumonia and chronic bronchitis, as well as bacterial, viral and fungal lung infections.

Credit: NYT

Credit: NYT

What is chronic lung disease?

According to the American Lung Association, chronic lung disease prevents the lungs and respiratory system from working correctly. It manifests in three ways: restrictive lung diseases, obstructive lung diseases and pulmonary vascular lung diseases.

Restrictive lung diseases include conditions that inflame or scar the lungs, including pulmonary fibrosis and sarcoidosis. Obstructive lung diseases include asthma and chronic bronchitis, diseases that often cause thick mucus buildup along the lungs' air sacs. Pulmonary vascular lung diseases, which include pulmonary hypertension and pulmonary embolism, concern the organ's blood vessels.

While there is no cure, there are ways to improve your symptoms and manage chronic lung disease. According to the ALA, people living with the disease should stay up to date on vaccinations that prevent respiratory infections like flu or pneumonia, eat healthy foods and continue to stay active.

What is bronchitis?

Stuffy nose, chest congestion, wheezing — bronchitis symptoms range from light fatigue to coughing up mucus. The ALA reported that the lung infection can often go away on its own after running its natural course for several weeks.

However, Francis is prone to bronchitis in winter because of his preexisting lung disease. As a viral infection, antibiotics are not an effective treatment so it's important to rest and drink plenty of water, which can help loosen chest congestion.

ExploreHow the extreme cold can affect your lungs

Chronic bronchitis is a more serious condition that develops over time. While symptoms may get better or worse, the ALA reports they will never completely go away.

What is double pneumonia?

According to the ALA, pneumonia can have mild, even unnoticeable, symptoms. Other times, however, the signs are severe. The lung disease sometimes causes coughs that produce mucus (sometimes blood), fever, sweating, shaking, rapid breathing, sharp chest pain, loss of appetite, nausea and confusion. Fevers can reach as high as 105 degrees.

When the disease affects both lungs, it is referred to as double (or bilateral) pneumonia. The lungs become infected, inflaming the air sacs within. The inflammation leads to a buildup of fluid, which makes breathing difficult.

According to the American Thoracic Society, adults who survive pneumonia sometimes still face long-term effects, including cognitive decline and an overall worsening quality of life for months to years.

From 1999 to 2019, an estimated 2.1% of all U.S. Deaths were caused by pneumonia. It remains the single largest infection-related cause of death among children worldwide, according to the World Health Organization.

When should you call a doctor about lung disease?

Different lung diseases come with different symptoms, but there are commonalities between them. According to the Yale School of Medicine, patients should consider making an appointment with a pulmonologist if they are experiencing shortness of breath, a persistent cough, recurring chest infections, loud snoring at night or excessive sleepiness during the day.

ALA advised patients to seek a pulmonologist in consultation with their primary care provider if their cough persists for more than three weeks or becomes severe.

"A simple cough associated with allergies or a cold shouldn't send you looking for a pulmonary specialist," according to the association's website. "Urgent care or your primary care doctor should be your first stop, and then on to an allergist or ear, nose and throat (ENT) specialist."

Some diseases come with extra caution signs, however. Because it can be deadly, especially to children, the ALA advises anyone who believes they have pneumonia to seek medical treatment before it gets worse.

"And see your doctor right away if you have difficulty breathing, develop a bluish color in your lips and fingertips, have chest pain, a high fever, or a cough with mucus that is severe or is getting worse," states the ALA website.

Adults older than 65, children 2 or younger and people with underlying medical conditions or weakened immune systems are considered high-risk groups.

Bronchitis, on the other hand, is something the ALA is only as concerned with when its chronic.

"On average, the symptoms of acute bronchitis last only a couple of weeks," the website said. "However, if you have a cough that won't go away, or if you get sick with bronchitis frequently, it may be the sign of a more serious disease and you should visit your doctor."

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Pulmonary Hypertension And Outcomes In Infants With Bronchopulmonary Dysplasia

Photo Credit: tangwitthayaphum

The following is a summary of "Characteristics associated with death or tracheostomy in infants with bronchopulmonary dysplasia following predominant non-invasive respiratory support," published in the February 2025 issue of Journal of Perinatology by Morris et al. 

Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants, particularly those requiring supplemental oxygen or prolonged oxygen therapy. The underdeveloped alveoli in these infants lacks sufficient maturity to function effectively, increasing the risk of respiratory complications.

Researchers conducted a retrospective study to identify factors linked to death or tracheostomy (D/T) in preterm infants with BPD managed primarily with non-invasive support before 36 weeks postmenstrual age (PMA). 

They conducted a retrospective cohort study at Children's Hospital of Philadelphia on 134 infants from 2010 to 2017. They assessed clinical characteristics as predictor variables for D/T, analyzing those with P < 0.10 in bivariable logistic regression using multivariable models. 

The results showed that 21 infants (16%) had D/T. Pulmonary vasodilator use and pulmonary hypertension (PH) on echocardiogram at 36 weeks PMA were linked to D/T in bivariable analyses, with vasodilator use remaining significant in multivariable models. 

Investigators found a strong association between PH and D/T, highlighting the need for early PH identification in high-risk infants with BPD. 

Source:nature.Com/articles/s41372-025-02234-z

Study Highlights More Than 3 Fold Higher Risk Of Pulmonary Complications In SLE Patients

South Korea: A large-scale Korean population-based longitudinal study has revealed that individuals with systemic lupus erythematosus (SLE) face a significantly higher risk of developing pulmonary complications.

"SLE patients had a significantly higher risk of pulmonary complications than matched controls, with the highest risk observed for pulmonary hypertension (aHR 14.66) and interstitial lung disease (aHR 9.58). Overall, SLE was associated with a 3.3-fold increased risk, highlighting the importance of vigilant pulmonary monitoring in this population," the researchers reported in RMD Open: Rheumatic & Musculoskeletal Diseases.

SLE, a chronic autoimmune disorder, is known to affect multiple organ systems, including the lungs. While pulmonary complications are recognized in SLE, their precise risk and long-term impact have remained incompletely understood. To address this gap, Bo-Guen Kim, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of), and colleagues aimed to assess the likelihood of pulmonary manifestations in individuals with SLE compared to matched controls.

For this purpose, the researchers utilized data from the Korean National Health Insurance Service (2009–2017) to identify 6,074 individuals aged ≥20 years with newly diagnosed SLE. These patients were matched by age and sex (1:10 ratio) with 60,740 controls who had no prior pulmonary manifestations.

The study revealed the following findings:

Over a mean follow-up of 9.3±2.7 years, the incidence of pulmonary manifestations was 15.2 per 1000 person-years in the SLE cohort and 4.5 per 1000 person-years in the matched cohort.

SLE patients had a significantly higher risk of pulmonary manifestations (aHR 3.26).

The highest risk was observed for pulmonary hypertension (aHR 14.66).

Interstitial lung disease had an elevated risk (aHR 9.58).

Pleural disorders were more common in the SLE group (aHR 3.29).

Pulmonary embolism risk was increased (aHR 2.66).

SLE patients had a higher likelihood of tuberculosis (aHR 2.35).

Acute respiratory distress syndrome and hemorrhage were more frequent (aHR 1.85).

Lung cancer risk was also elevated (aHR 1.41).

The researchers acknowledged several limitations in their study. Diagnoses of SLE, pulmonary manifestations, and comorbidities were based on ICD-10 codes, which could lead to misclassification. To minimize this, they used both ICD-10 codes and the RID program registration code for SLE. The lack of serological and radiologic data limited the ability to assess factors such as autoantibodies, disease overlap, and the role of antiphospholipid syndrome in severe pulmonary complications. Additionally, since the study was based on a Korean dataset, further research on diverse populations is needed to validate these findings.

Despite these limitations, the researchers concluded that SLE patients had an approximately 3.3-fold higher risk of pulmonary manifestations compared to matched controls, with particularly high risks for interstitial lung disease and pulmonary hypertension.

Reference:

Kim BG, Kim J, Eun Y, Park DW, Kim SH, Lee H. Comprehensive risk assessment for pulmonary manifestations in systemic lupus erythematosus: a large-scale Korean population-based longitudinal study. RMD Open. 2025 Feb 23;11(1):e005267. Doi: 10.1136/rmdopen-2024-005267. PMID: 39988351.

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