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Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus
Online ISSN 1827-1723
Coker R. K.
Respiratory Medicine Hammersmith Hospital Imperial College Healthcare NHS Trust London, UK
Occurring world-wide, sarcoidosis is the commonest diffuse parenchymal lung disease (DPLD). It affects all ethnic groups, but prevalence and severity vary significantly between different races. This has complicated interpretation of clinical studies and extrapolation of the findings to different populations. Pulmonary disease is present in over 90% of patients. Oral corticosteroids have been employed in the treatment of sarcoidosis since the 1950s, and there is evidence of short to medium term response in symptoms, respiratory function and radiology. More recent studies have investigated the possible benefit of inhaled steroids. The long-term effects of steroid treatment are, however, unclear. Existing international guidelines addressing the treatment of sarcoidosis represent a consensus statement endorsed by North American and European respiratory societies. British guidelines on DPLD, which cover sarcoidosis, were published almost simultaneously. Guidelines agree in some areas while for others uncertainty prevails. This review examines the use of corticosteroids and alternative immunosuppressant agents in treating pulmonary sarcoidosis. Questions of particular interest are: which patients should be treated, when treatment should be started, whether inhaled steroids have a place in management, how long treatment should continue, and how best to screen patients for possible adverse effects.