Monitoring Pulmonary Sarcoidosis

Abstract

The monitoring of serial changes in disease severity is an essential part of the clinical management of pulmonary sarcoidosis. Historically, symptomatic change, pulmonary function trends, and changes on serial imaging have all been evaluated in routine practice. However, each of these three domains has significant limitations when used in isolation. Symptomatic change is confounded by the long list of causes, other than change in the severity of interstitial lung disease, for serial reductions in exercise tolerance. The interpretation of pulmonary function trends is complicated by (a) the major heterogeneity in pulmonary function patterns in sarcoidosis; (b) the limitations of thresholds for “significant” change; and (c) the fact that pulmonary function trends do not always represent changes in the severity of pulmonary sarcoidosis. Serial chest radiography is somewhat insensitive in the detection of change and uncertainties exist on the optimal method of quantifying radiographic change. Given these limitations, a multidisciplinary approach is required in the routine monitoring of pulmonary sarcoidosis, with the reconciliation of symptomatic change, radiographic change, and pulmonary function trends, although no guidance on this process exists in current guidelines. This principle applies equally to defining responses to treatment, detecting changes in disease severity in other contexts and the identification of increasing pulmonary vascular disease.