Endoluminal Stenosis of Proximal Bronchi in Sarcoidosis

Chambellan, Arnaud; P, Turbie; Nunès, Hilario; Brauner, M.; Battesti, J P; Valeyre, Dominique

doi:10.1378/chest.127.2.472

Cited by 97 publications

(81 citation statements)

References 28 publications

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“…Improvement in FEV1 without changes in FVC can be seen in some cases when airway obstruction is the major manifestation of the disease [40]. Airway stenosis may be unresponsive to antiinflammatory therapy, especially if not treated within the first 6 months of onset of airflow limitation [41].…”

Section: Pulmonary Functionmentioning

confidence: 99%

“…This condition responds best to anti-inflammatory therapy instituted within 6 months of onset. Prolonged obstruction is unlikely to respond to glucocorticoids [41]. Sarcoidosis associated pulmonary hypertension rarely responds to anti-inflammatory therapy, but some patients have had a significant improvement in symptoms with pulmonary vasodilator therapy [74].…”

Section: Other Measuresmentioning

confidence: 99%

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Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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The treatment options for pulmonary sarcoidosis have increased over the past 10 years. As new treatments have been introduced, the best way to assess and compare treatments remains unknown. The goal of this review is to discuss the standard treatments for pulmonary sarcoidosis, including glucocorticoids, and cytotoxic agents, such as methotrexate, azathioprine and leflunomide, and compare them to the newer biological agents, such as infliximab and adalimumab. We also discuss some novel treatments which are currently being evaluated. To compare these different regimens, we look at the measures used to assess response. These include pulmonary function, chest imaging, steroid sparing potential and, more recently, improvements in quality of life measures. While there is, as yet, no standard assessment for response, there is a growing consensus that response to treatment may include improvement of one or more of the following: forced vital capacity, chest imaging and steroid sparing. Several drugs used for pulmonary sarcoidosis have demonstrated improvement in one or more of these measures.

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Section: Pulmonary Functionmentioning

confidence: 99%

Section: Other Measuresmentioning

confidence: 99%

Established and experimental medical therapy of pulmonary sarcoidosis

et al. 2013

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“…Udwadia et al [19] reported that all patients (n=12) with bronchostenosis showed an obstructive pattern in their study. Chambellan et al [20] reported that FEV 1 /FVC <70 in 12 (66.7%) of 18 patients who had endobronchial stenosis, external compression due to LAP was present in two (11%) of these patients. It is highly possible that the difference between our results and previous studies resulted from the criteria that we used for bronchial stenosis.…”

Section: Discussionmentioning

confidence: 97%

Effects of Lymphadenopathy on Pulmonary Function tests in Sarcoidosis

et al. 2013

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oBJectIVe:The pulmonary function test (PFT) is an important quantification test in the follow-up of sarcoidosis patients. We aimed to investigate the effect of lymphadenopathy (LAP) after controlling pulmonary parenchymal involvement on pulmonary function tests (PFTs) in the context of sarcoidosis. MAterIAl And Methods:A total of 63 sarcoidosis patients were enrolled retrospectively in the study. Respiratory functions were evaluated via PFTs. Radiological evaluations of the patients were made with chest x-ray and high-resolution computerized tomography (HRCT). Bronchoscopic investigations were performed on all patients. Possible factors that affect PFTs were evaluated.resUlts: There was a statistically significant correlation between the bronchoscopic findings and PFTs parameters (p<0.01). Forced vital capacity (FVC) was affected more in the presence of LAP in the adjacent bronchi and, it was similar the same for forced expiratory volume in the first second (FEV 1 ). Considering the grade of HRCT findings, the presence of hilar LAP, intrahilar LAP and lobar LAP had a statistically significant effect on FVC and FEV 1 (p=0.001). conclUsIon:We revealed that in addition to parenchymal involvement of the disease, the special localization of lymph node involvement also has an important effect on the PFTs parameters of sarcoidosis patients. IntrodUctIonSarcoidosis is a multi-systemic disease characterized by noncaseating inflammatory histopathologic findings. It commonly affects lung and mediastinal lymph nodes. Although patients commonly present with pulmonary signs, sarcoidosis may present with all types of organ involvement.Clinical evaluation, chest x-ray, pulmonary function test (PFTs), and high-resolution computerized tomography (HRCT) are important tools in the diagnosis of the disease [1][2][3]. PFTs and HRCT are also important for the followup of the progression and activation of the disease [3][4][5]. In addition to restrictive respiratory dysfunction, obstructive dysfunction can also be observed in sarcoidosis. There is a correlation between PFTs and the stage and prognosis of the disease [2]. Lymph node involvement is present in stages I and II; lung parenchyma involvement of the disease is present in all stages, except stages 0 and I of the disease [6]. There are some studies in the literature showing a relationship between the presence of radiologic findings and PFTs, however, there is no previous study, according to our knowledge, investigating separately the parenchymal involvement and individual lymph node involvement effect on PFTs [2,5].

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“…Significant bronchial stenosis is very rare and may occur at any stage of the disease [108]. Obstruction may be the consequence of endobronchial granulomatous involvement and extrinsic compression by enlarged lymph nodes [61].…”

Section: Bronchial Stenosismentioning

confidence: 99%

Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function

et al. 2012

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Imaging has a prominent role in the assessment of sarcoidosis diagnosis and outcome, which are extremely variable. Chest radiography staging helps predict the probability of spontaneous remission, and stage IV is associated with higher mortality. However, the reproducibility of reading is poor and changes in radiography and lung function are inconsistently correlated, which may be problematic for the monitoring of disease and treatment response. Chest computed tomography (CT) makes a great diagnostic contribution in difficult cases. Bilateral hilar lymphadenopathy with peri-lymphatic micronodular pattern is highly specific for sarcoidosis. CT is important for the investigation of pulmonary complications, including aspergilloma and pulmonary hypertension. CT improves the yield of bronchoscopy for obtaining a positive endobronchial or transbronchial biopsy. CT findings may also discriminate between active inflammation and irreversible fibrosis, with occasional influence on therapeutic decisions. Three CT patterns of fibrotic sarcoidosis are identified, with different functional profiles: predominant bronchial distortion is associated with obstruction; honeycombing is associated with restriction and lower diffusing capacity of the lung for carbon monoxide; whereas functional impairment is relatively minor with linear pattern. The clinical impact of correlations between CT severity scores and functional impairment is uncertain, except for its utility elucidating the mechanisms of airflow limitation, which include bronchial distortion, peribronchovascular thickening, air-trapping and bronchial compression by lymphadenopathy.

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Endoluminal Stenosis of Proximal Bronchi in Sarcoidosis

Cited by 97 publications

References 28 publications

Established and experimental medical therapy of pulmonary sarcoidosis

Established and experimental medical therapy of pulmonary sarcoidosis

Effects of Lymphadenopathy on Pulmonary Function tests in Sarcoidosis

Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function

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