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* From Service de Pneumologie (Drs. Lavergne, Sadoun, Battesti, and Valeyre), Service de Physiologie (Dr. Clerici), and Service de Radiologie (Dr. Brauner), Hôpital Avicenne (Assistance Publique-Hôpitaux de Paris), UFR Bobigny, Bobigny, France.
Correspondence to: Dominique Valeyre, MD, Service de Pneumologie, Hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny Cédex, France; e-mail: dominique.valeyre{at}avc.ap-hop-paris.fr
Study objective: Airway obstruction (AO) in sarcoidosis is reported to be associated with respiratory symptoms, increased morbidity, and an increased mortality risk. Because AO in sarcoidosis may result from several causes, the therapeutic benefit of corticosteroids is difficult to determine. The aim of this study was to evaluate the therapeutic response of AO attributable to sarcoid granulomas in the bronchial wall.
Patients: We selected 11 patients who had sarcoidosis with AO (defined as FEV1/vital capacity [VC] < 70%) associated with sarcoid granulomas on an endobronchial biopsy. Exclusion criteria were history of asthma, smoker or exsmoker, stage 4 disease, evidence of extrinsic compression by enlarged lymph nodes, and localized endobronchial stenosis seen during fiberoptic bronchoscopy.
Interventions: We compared the results of pulmonary function tests and clinical, radiologic, and biological findings at baseline with those obtained at the time of the last pulmonary function tests available, between the sixth and 12th months of treatment. Eight patients took oral corticosteroids (20 to 60 mg/d initially), one received IV methylprednisolone pulses, another took oral hydroxychloroquine, and the last one received IM methotrexate.
Measurements and results: With treatment, FEV1 and FEV1/VC significantly improved in eight patients (72%), normalized in four patients, and was unchanged in the remaining three patients. The mean FEV1 increased from 60.8 ± 10.8% to 76 ± 13.7% of the predicted value (p < 0.02). VC did not change significantly. FEV1/VC increased from 76.1 ± 6.4% to 87.6 ± 10.7% of the predicted value (p < 0.01). Dyspnea on exertion and other clinical findings were attenuated in 10 patients; the chest radiograph improved in 9 patients, and normalized in 5 patients. The mean serum angiotensin-converting enzyme level decreased from 112 ± 48 to 58 ± 40 IU/mL (p < 0.05), and normalized in four patients.
Conclusion: The present study indicates that AO caused by sarcoid granulomas in the bronchial wall can be either partially or completely reversed by treatment with a concomitant attenuation of pulmonary symptoms.
Key Words: bronchi • obstructive lung diseases • respiratory function tests • sarcoidosis • treatment outcome
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