Chest
Volume 130, Issue 6, December 2006, Pages 1851-1856
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Original Research: Sarcoidosis
Clinical and Radiographic Indices Associated With Airflow Limitation in Patients With Sarcoidosis

https://doi.org/10.1378/chest.130.6.1851Get rights and content

Background

Airflow limitation is found in some patients with sarcoidosis, and it is associated with a poor prognosis. The aim of this study was to investigate clinical and radiographic indices associated with airflow limitation in patients with sarcoidosis.

Methods

A prospective, observational study was performed on 228 consecutive sarcoidosis patients followed up at our patient clinic at the Central Clinic of Kyoto. Patients underwent pulmonary function tests, and high-resolution CT (HRCT) of the lung was evaluated for the presence of lymph node enlargement, lung opacity, reticular shadow, and thickening of bronchovascular bundles (BVB). Airflow limitation was defined as FEV1/FVC < 70%. Airway reversibility was tested in subjects with airflow limitation. The frequency of airflow limitation was evaluated, and clinical and radiographic parameters were compared between patients with and without airflow limitation.

Results

Among all 228 subjects, 20 subjects (8.8%) had airflow limitation, and none showed airway reversibility. Patients with airflow limitation were predominantly male, smokers, and had advanced chest radiographic stage, increased frequency of lung opacities, reticular shadows, and thickened BVB on HRCT. Stepwise regression analysis showed that chest radiographic stage IV, higher age, smoking, and thickened BVB were independently associated with lower FEV1/FVC.

Conclusion

The frequency of airflow limitation was 8.8% in Japanese sarcoidosis patients. Chest radiographic stage IV, higher age, smoking, and thickened BVB were associated with airflow limitation in patients with sarcoidosis.

Section snippets

Study Population

The study population comprised 228 Japanese sarcoidosis patients with histologic confirmation of disease diagnosis. All patients were consecutively followed up at the outpatient sarcoidosis clinic in the Central Clinic of Kyoto. Patients with concurrent lung diseases were excluded from the study. All study subjects underwent pulmonary function tests (PFTs), and high-resolution CT (HRCT) was performed on the same day. Classification of chest radiographs (stage 0, normal; stage I, bilateral hilar

Frequency of Airflow Limitation

Twenty of the 228 subjects (8.8%) had prebronchodilator FEV1/FVC < 70%, which fulfilled the criteria of airflow limitation. Postbronchodilator increase in FEV1 ranged from − 20 to 220 mL (average, 60 mL), and percentage increase in FEV1 ranged from − 2.3 to 9.7% (average, 3.8%). Thus, all of these subjects were considered to have irreversible airflow limitation. In all of these subjects, postbronchodilator FEV1/FVC was also < 70%.

Comparison of Patient Characteristics

Patient characteristics of the study subjects are shown in Table 1

Discussion

Although pulmonary sarcoidosis mainly affects parenchyma of the lung, studies of physiologic,6, 13, 14 radiologic,15, 16, 17 and pathologic approaches2, 34, 18, 19 have revealed that airway lesions are not rare in patients with sarcoidosis. It was also reported that sarcoidosis patients with FEV1/FVC < 70% had increased mortality risk (odds ratio, 1.9) compared with those with FEV1/FVC ≥ 70%.20 However, clinical indices associated with airflow limitation have not been fully elucidated in

ACKNOWLEDGMENT

We thank Mr. S. Ueda, Ms. M. Aoki, Ms. M. Koshimura, and Ms. K. Tanaka for technical assistance.

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    The authors have no financial or other potential conflicts of interest to disclose.

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