Obstructive sarcoidosis

Abstract

Introduction: Sarcoidosis is a multisystemic granulomatous disease of unknown cause, that mainly affects the lungs. Being an interstitial lung disease, it is generally accepted that sarcoidosis demonstrates mostly a restrictive pattern in pulmonary function tests. Some authors mention that sarcoidosis could show an obstructive pattern also, but to a lesser extent. Aim: to assess the frequency of the obstructive and restrictive patterns in patients with pulmonary sarcoidosis using pulmonary function tests. Materials and methods: We performed an analysis of 95 patient's clinical records with biopsy proven or highly suggestive of sarcoidosis, cases registered in a third level medical institution, during year 2011. All the patients underwent chest X ray and pulmonary function tests. Results: Our study group consisted of 74 (77,9%) females and 21 (22,1%) males, mean age 49,5±9,0. In our group, 86 (90,5%) were non-smokers, ex-smokers - 4 (4,2%), and current smokers - 5 (5,3%). According to the radiological stages we had 25 (26,9%) subjects in stage I, 49 (52,7%) in stage II, 13 (14,0%) - stage III and stage IV - 6 (6,5%) patients. We found decreased FEV1 and decreased FEV1/FVC only in 8 (8,4%) cases, but we have also found other functional signs of obstruction, like decreased MMEF25 75%in 51 (53,7%) cases, suggesting small airway obstruction; increased RV in 40 (42,1%) cases - corresponding to the air-trapping phenomenon, and increased TLC in 20 (21,3%) cases - suggesting hyperinflation. In contrast, we found only 15 (15,7%) cases of concomitant decrease of FVC and normal or increased FEV1/FVC, suggestive of restrictive pattern, also decreased TLC in 8(8,5%) subjects, decreased RV in 4(4,3%) cases; concomitant decreased FVC, increased FEV1/FVC and decreased TLC - in 8 (8,5%) cases. Conclusion: Our study showed that pulmonary sarcoidosis determines more obstructive defects than restrictive, depending on how we define obstruction.