Your Scleroderma Questions, Answered is a monthly Q&A column featuring responses from the SRF’s Chief Medical Officer, Dr. Gregory Gordon, who shares guidance grounded in decades of clinical expertise.
In this edition, he answers questions about the impacts of scleroderma on a lung transplant, and information about exercises that can be helpful for people living with SSc-ILD.
Question: If someone gets a lung transplant, what prevents the scleroderma from affecting the new lungs?
Answer: After a lung transplant, the patient’s scleroderma will not directly affect the new lungs. But that does not mean there are no concerns.
Scleroderma-associated lung disease develops through a slow process in which the patient’s immune system attacks healthy, native tissue. The immune system produces autoantibodies directed at the lung, which injure the small blood vessels and delicate lining cells. That injury triggers local fibroblasts, leading to lung fibrosis. This process typically builds gradually over years and depends on repeated, ongoing injury over a long period of time. Donor lungs carry none of this history and the patient’s autoantibodies will not interact with it in the same way. So,the patient’s scleroderma does not directly damage the new lung tissue.
That said, the donor lungs are not entirely insulated from the surrounding disease environment. They sit within a body that still has scleroderma-related blood vessel changes, circulating autoantibodies, and other systemic effects. Symptoms from other organs, such as reflux from the GI tract, can still cause damage to the lungs.
So, while direct recurrence of the original disease process in the donor lung is unlikely, the new lungs remain vulnerable to injury from the continued, systemic effects of scleroderma.
Question: Are there exercises that can help improve lung function for those living with ILD?
Answer: Yes, exercise can help scleroderma-related ILD. Patients will often be prescribed pulmonary rehabilitation. It combines walking or light cycling with simple strength exercises, plus breathing techniques like pursed-lip and belly breathing to help ease shortness of breath. For people with scleroderma, programs often also include gentle stretching for the hands and joints, since stiffness and skin tightness from the disease can limit movement too.
These exercises improve muscle tone and conditioning, which helps people move more easily and feel less breathless day to day. But they do not improve the underlying lung disease or repair existing lung scarring.
Because safe exercise depends on a person’s overall health, it’s best to start under the guidance of a pulmonologist or physical therapist rather than beginning exercise alone. Some people use supplemental oxygen during exercise, even if they don’t need it at rest.
