Pulmonary Sarcoidosis

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What is sarcoidosis?

Sarcoidosis is a rare disease that results from inflammation. Currently, the cause is unknown. It usually develops between 20 to 50 years of age. Almost ninety percent of the cases of sarcoidosis are found in the lungs, but it can occur in almost any organ. It causes small lumps, or granulomas, which generally heal and disappear on their own. However, for those granulomas that do not heal, the tissue can remain inflamed and become scarred, or fibrotic.

Pulmonary sarcoidosis can develop into pulmonary fibrosis, which distorts the structure of the lungs and can interfere with breathing. Bronchiectasis, a lung disease in which pockets form in the air tubes of the lung and become sites for infection, can also occur.

What are the symptoms of sarcoidosis?

Most sarcoidosis patients do not have symptoms and probably are unaware they have the disease. Pulmonary sarcoidosis can cause loss of lung volume (the amount of air the lungs can hold) and abnormal lung stiffness.

The following are the most common symptoms for sarcoidosis. However, each individual may experience symptoms differently. Symptoms may include:

• Shortness of breath

• Cough that will not go away

• Skin rashes on face, arms, or shins

• Inflammation of the eyes

• Weight loss

• Fatigue

• Night sweats

• Fever

• Pain in the chest, joints, and bones

• Swollen lymph nodes

• Wheezing

The symptoms of sarcoidosis may resemble other conditions or medical problems. Consult your doctor for a diagnosis.

Who is at risk for sarcoidosis?

Sarcoidosis occurs in all races and both genders, but the most susceptible populations seem to be of African-American, Scandinavian, Asian, German, Irish, or Puerto Rican origin.

Diagnosis of sarcoidosis

In addition to a complete medical history and physical examination, diagnostic procedures may include:

• Chest X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film.

• Pulmonary function tests. Diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines into which the person must breathe.

• Blood tests. To analyze the amount of carbon dioxide and oxygen in the blood.

• Bronchoscopy. A long, thin, flexible tube with a light at the end is put into the lung. This allows the doctor to look at the tissue lining the air passageways. Lung tissue samples (biopsies) and lung washings (lavage) that contain lung cells from the lungs can be done through the bronchoscope.

• Bronchoalveolar lavage. A procedure in which a sterile saline solution is put into the lungs through a bronchoscope (a flexible tube for examining the bronchi) and then suctioned out. The bronchoalveolar lavage may be performed to diagnose lung conditions and infections.

• Biopsy. A  test in which a small piece of abnormal tissue is taken out and checked under a microscope.  

Sarcoidosis is usually diagnosed by elimination. That is, other lung disorders that have similar symptoms are progressively eliminated, leading to a diagnosis of sarcoidosis.

Treatment for sarcoidosis

Specific treatment will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

Different treatments work better for different people. Sometimes more than one treatment is used, and in many cases, no treatment is needed. Most medications used to treat sarcoidosis suppress the immune system.

Treatment may include the use of corticosteroids, such as prednisone. Other medicines, such as methotrexate, may be used if corticosteroids do not work, you wish to avoid side effects of corticosteroids, or your sarcoidosis gets worse.