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Rabahoğlu B, Oymak FS, Baran Ketencioğlu B, Tutar N, Gülmez İ, Yılmaz İ. Frequency of peripheral blood eosinophilia and obstructive airway disease in sarcoidosis. Turk J Med Sci 2021; 51:3001-3007. [PMID: 36161645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/04/2021] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. METHODS The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. RESULTS A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 µL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. DISCUSSION Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis.
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Affiliation(s)
- Bilal Rabahoğlu
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Fatma Sema Oymak
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | | | - Nuri Tutar
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - İnci Gülmez
- Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - İnsu Yılmaz
- Division of Immunology and Allergy, Department of Pulmonary Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
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Kiyat P, Palamar M, Gerceker Turk B. Dry eye and Meibomian gland dysfunction evaluation in sarcoidosis patients. Eur J Ophthalmol 2021; 32:11206721211006579. [PMID: 33832342 DOI: 10.1177/11206721211006579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze the relation between Meibomian gland dysfunction, dry eye, and sarcoidosis. MATERIALS AND METHODS Twenty eyes of 10 sarcoidosis patients (Group 1) and 20 left eyes of 20 age-sex matched healthy volunteers (Group 2) were included. Presence of dry eye was evaluated with Schirmer 1 test, tear film break-up time (T-BUT), Oxford scale scoring, Ocular Surface Disease Index (OSDI) score assessments. A slit-lamp biomicroscope infrared filter (Topcon, SL-D701, IJssel, The Netherlands) was used to evaluate Meibomian glands. The drop-out ratio according to meibography was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total Meibomian gland area). RESULTS Among dry eye tests mean Schirmer 1 and T-BUT values were lower and OSDI score was higher in Group 1 compared to Group 2 and the differences were statistically significant (p = 0.017, p = 0.039, p = 0.003, respectively). In addition, the upper, lower and total meiboscores were statistically significantly higher in Group 1 (p = 0.047, p = 0.003, p = 0.005, respectively). CONCLUSION A significantly higher presence of dry eye and Meibomian gland drop out ratios was detected in sarcoidosis patients. It is important to monitor sarcoidosis patients for dry eye and Meibomian gland dysfunction and when detected, to treat adequately to prevent ocular surface damage.
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Affiliation(s)
- Pelin Kiyat
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Bengu Gerceker Turk
- Department of Dermatology, Ege University Faculty of Medicine, Izmir, Turkey
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Lui JK, Mesfin N, Tugal D, Klings ES, Govender P, Berman JS. Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis. J Intensive Care Med 2021; 37:441-458. [PMID: 33611981 DOI: 10.1177/0885066621993041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nathan Mesfin
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Derin Tugal
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Govender
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey S Berman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
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Thunold RF, Løkke A, Cohen AL, Ole H, Bendstrup E. Patient reported outcome measures (PROMs) in sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:2-17. [PMID: 32476819 DOI: 10.36141/svdld.v34i1.5760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
Patients with sarcoidosis present with a variety of symptoms which may impair many aspects of physical and mental well-being. Traditionally, clinicians have been concerned with physical health aspects of sarcoidosis, assessing disease activity and severity with radiological imaging, pulmonary function and blood tests. However, the most reported symptom of sarcoidosis patients, fatigue, has been shown not to correlate with the most commonly used parameters for monitoring disease activity. Studies have shown poor agreement between physicians and patients in assessing sarcoidosis symptoms. This underlines the importance of patient reported outcomes (PROs) in addition to traditional outcomes in order to provide a complete evaluation of the effects of interventions in clinical trials and everyday clinical assessment of sarcoidosis. We have undertaken a systematic review to identify and provide an overview of PRO concepts used in sarcoidosis assessment the past 20 years and to evaluate the tools used for measuring these concepts, called patient reported outcome measures (PROMs). Various PROMs have been used. By categorizing these PROMs according to outcome we identified the key PRO concepts for sarcoidosis to be Health Status and Quality of Life, Dyspnea, Fatigue, Depression, Anxiety and Stress and Miscellaneous. There is no perfect sarcoidosis-specific PROM to cover all concepts and future intervention studies should therefore contain multiple complementary questionnaires. Based on our findings we recommend the Fatigue Assessment Scale (FAS) for assessing fatigue. Dyspnea scores should be chosen based on their purpose; more research is needed to examine their validity in sarcoidosis. The Modified Medical Research Council Dyspnea Scale (MRC) can be used to screen for dyspnea and the Baseline Dyspnea Index (BDI) to detect changes in dyspnea. We recommend The World Health Organization Quality of Life assessment instrument (WHOQOL-100) for assessing quality of life, although a shorter questionnaire would be preferable. For assessing health status we recommend the Sarcoidosis Assessment Tool (SAT), and have great expectations for this new and promising assessment tool. Supplementary to the WASOG meeting of 2011's recommendation on assessing QoL, we recommend incorporating fatigue, dyspnea and HS assessment in clinical trials and everyday clinical assessment of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 2-17).
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Affiliation(s)
- Rikke Flor Thunold
- Department of Internal Medicine Orkdale, St. Olavs University Hospital, Trondheim, Norway
| | - Anders Løkke
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Langballe Cohen
- Department of Internal Medicine Orkdale, St. Olavs University Hospital, Trondheim, Norway
| | - Hilberg Ole
- Department of Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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Wu CH, Chung PI, Wu CY, Chen YT, Chiu YW, Chang YT, Liu HN. Comorbid autoimmune diseases in patients with sarcoidosis: A nationwide case-control study in Taiwan. J Dermatol 2016; 44:423-430. [PMID: 27786368 DOI: 10.1111/1346-8138.13654] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/10/2016] [Indexed: 11/29/2022]
Abstract
The association between sarcoidosis and autoimmune comorbidities has been reported, however, it has seldom been confirmed by a large nationwide study. Our study aimed to clarify the association between sarcoidosis and autoimmune comorbidities in the Taiwanese. A total of 1237 patients with sarcoidosis and 4948 age- and sex-matched control subjects were selected from the National Health Insurance Research Database of Taiwan from 1997 to 2010. Multiple logistic regressions were performed to calculate the odds of comorbidities between the two groups. The prevalence of sarcoidosis was 2.17/100 000 individuals in Taiwan. Sarcoidosis patients tended to run a higher risk of autoimmune comorbidities than the control group (17.6% vs 9.4%, P < 0.05). Autoimmune thyroid disease (adjusted odd ratio [aOR], 1.32; 95% confidence interval [CI], 1.05-1.64), Sjögren's syndrome (aOR, 11.6; 95% CI, 4.36-31.0) and ankylosing spondylitis (aOR, 3.80; 95% CI, 2.42-5.97) were significantly associated with sarcoidosis. The sex-stratified analyses were carried out to demonstrate a significant association of sarcoidosis with ankylosing spondylitis in both sexes, but with autoimmune thyroid disease in male patients and with Sjögren's syndrome female patients, respectively. Besides, the diagnosis of the autoimmune comorbidities strongly associated with sarcoidosis tended to be established after that of sarcoidosis. This study demonstrated that patients with sarcoidosis tended to have autoimmune thyroid disease, Sjögren's syndrome and ankylosing spondylitis, and the diagnosis of sarcoidosis usually preceded that of associated comorbidities. Clinicians should be alert to autoimmune comorbidities in patients with sarcoidosis.
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Affiliation(s)
- Chi-Hung Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Pei-I Chung
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Ta Chen
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Wen Chiu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Han-Nan Liu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, National Defense Medical Center, Taipei, Taiwan
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Yang IA, Ko FWS, Lim TK, Hancox RJ. Year in review 2012: asthma and chronic obstructive pulmonary disease. Respirology 2013; 18:565-72. [PMID: 23316705 DOI: 10.1111/resp.12049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/08/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.
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Eves ND, Song Y, Piper A, Maher TM. Year in review 2012: acute lung injury, interstitial lung diseases, sleep and physiology. Respirology 2013; 18:555-64. [PMID: 23336426 DOI: 10.1111/resp.12053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 01/16/2013] [Indexed: 01/14/2023]
Affiliation(s)
- Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Kalkanis A, Judson MA. Distinguishing asthma from sarcoidosis: an approach to a problem that is not always solvable. J Asthma 2012; 50:1-6. [PMID: 23215952 DOI: 10.3109/02770903.2012.747204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Because pulmonary sarcoidosis often affects the airway, it is commonly confused with asthma. METHODS This article reviews the mechanisms of airflow obstruction in sarcoidosis, the symptoms associated with this phenomenon, and the approach to distinguish sarcoidosis from asthma. DISCUSSION Because asthma is highly likely in a patient with wheeze, cough, and chest tightness, sarcoidosis is usually not considered unless the patient has extrapulmonary manifestations of sarcoidosis or a family history of the disease. When pulmonary sarcoidosis is a consideration, a chest radiograph should be performed. A chest radiograph should also be performed in an asthmatic patient when the presentation is atypical, or fails to respond to standard asthma treatment; chest radiography should be performed in this situation to consider not only pulmonary sarcoidosis but also other possible cardiopulmonary disorders. In a patient with confirmed pulmonary sarcoidosis, the diagnosis of concomitant asthma is problematic. The symptoms associated with the two disorders are often identical. Airflow obstruction is common in sarcoidosis so that pulmonary function testing is unlikely to differentiate these two diseases. Demonstration of airway hyperreactivity may fail to distinguish these disorders as this is common in sarcoidosis. Serum IgE, serum angiotensin-converting enzyme levels, sputum eosinophilia, and exhaled nitric oxide measurements show promise as distinguishing tests, although they have not been studied specifically. Pulmonary imaging is probably of limited value unless baseline studies are available for comparison. We suspect that historical information will be more useful in distinguishing these two diseases. Not infrequently, it may be impossible to exclude or confirm an asthmatic component in a confirmed pulmonary sarcoidosis patient. Fortunately, exacerbations of both these diseases are often treated with systemic corticosteroids initially. Significant variability in pulmonary symptoms and airflow obstruction suggest that an asthma component is present, and inhaled corticosteroids and bronchodilators should be considered in these cases, CONCLUSIONS Asthma and sarcoidosis share many of the same symptoms, as sarcoidosis commonly affects the airways. Therefore, it is problematic to distinguish these two diseases. In this article, we have outlined an approach to assess the presence of each of these diseases and an approach to therapy.
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Affiliation(s)
- Alexandros Kalkanis
- Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY 12208, USA
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Young LM, Good N, Milne D, Zeng I, Kolbe J, Wilsher ML. The prevalence and predictors of airway hyperresponsiveness in sarcoidosis. Respirology 2012; 17:653-9. [PMID: 22296033 DOI: 10.1111/j.1440-1843.2012.02137.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Obstructive airflow limitation is the most common physiological impairment in sarcoidosis. This study determined the prevalence of airway hyperresponsiveness (AHR) in sarcoidosis, the correlation between responses to direct (using histamine) and indirect (using hypertonic saline) bronchial challenge, and the clinical, physiological and radiological predictors of AHR. METHODS Subjects with sarcoidosis and a baseline forced expiratory volume in 1 s (FEV(1)) >35% predicted underwent hypertonic and histamine challenge, lung function testing and high resolution computed tomography (HRCT) of the chest. AHR was defined as a 15% fall in FEV(1) to hypertonic saline and a 20% fall in FEV(1) to histamine. RESULTS The 52 subjects had well-preserved lung function (FEV(1) = 2.8 ± 0.7 L, 87% predicted). AHR was detected in 5/47 (11%) to hypertonic saline and 19/43 (44%) to histamine challenge. On univariate analysis, response to histamine challenge was predicted by conglomerate fibrosis (P = 0.02) and reticular pattern (P = 0.03) on HRCT. The baseline % predicted forced expiratory volume in 1 s was significantly inversely associated with AHR on univariate (P = 0.004) and multivariate analysis (P = 0.01) when adjusted by HRCT patterns. CONCLUSIONS The higher prevalence of AHR using histamine challenge than hypertonic saline challenge and the association with baseline % predicted FEV(1) suggest that the AHR in sarcoidosis may reflect the consequences of airway remodelling following inflammation.
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Affiliation(s)
- Lisa M Young
- Green Lane Respiratory Services, University of Auckland, Auckland, New Zealand.
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Zappala C, Wells A. Aetiology and clinical phenotype still seem distant in sarcoidosis. Respirology 2012; 17:199-200. [PMID: 22221933 DOI: 10.1111/j.1440-1843.2011.02120.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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