Pulmonary Sarcoidosis

Sarcoidosis is a rare disease caused by inflammation. It often occurs in the lungs and lymph nodes, but it can occur in almost any organ.

Sarcoidosis in the lungs is called pulmonary sarcoidosis. It causes small lumps of inflammatory cells in the lungs. These lumps are called granulomas and can affect how the lungs work. The granulomas generally heal and disappear on their own. But, if they don’t heal, the lung tissue can remain inflamed and become scarred and stiff. This is called pulmonary fibrosis. It changes the structure of the lungs and can affect your breathing. Bronchiectasis can also occur. This is when the airways become thickened and widened from ongoing (chronic) inflammation or infection. But, these problems are not common. 

Experts don't know what causes pulmonary sarcoidosis. They think that bacteria, viruses, or chemicals might trigger the disease. It may also be genetic. This means a person is more likely to develop sarcoidosis if someone in their close family has it. This is an active area of research.

Most people with sarcoidosis don't have symptoms and likely don't know they have the disease. It can affect many organs, causing a variety of symptoms. Pulmonary sarcoidosis can reduce the amount of air the lungs can hold and cause lung stiffness.

Symptoms may be a bit different for each person. Symptoms may include:

• Shortness of breath, which often gets worse with activity.

• Dry cough that won't go away.

• Chest pain.

• Wheezing.

Sarcoidosis can also cause symptoms not directly related to the lungs, such as:

• Extreme tiredness (fatigue).

• Fever.

• Inflammation of the eyes and pain, burning, blurred vision, and light sensitivity.

• Night sweats.

• Pain in the joints and bones.

• Skin rashes, lumps, and color changes on face, arms, or shins.

• Swollen lymph nodes.

• Weight loss.

The symptoms of pulmonary sarcoidosis may look like other conditions or health problems. Talk with your healthcare provider for a diagnosis.

In addition to a complete health history and physical exam, tests used may include:

• Chest X-ray. This imaging test is used to assess the lungs, as well as the heart. Chest X-rays may show important information about the size, shape, and location of the lungs, large breathing tubes (bronchi), and the area in the middle of the chest separating the lungs (mediastinum).

• CT scan. This imaging test uses X-rays and computer technology to make horizontal images (called slices) of the body. A CT scan shows detailed images of any part of the body, including the lungs. CT scans are more detailed than regular X-rays. They can be used to diagnose lung diseases, watch disease progression, and assess response to treatment.

• Pulmonary function tests. These are tests that help to measure the lungs' ability to move air in and out of the lungs. The tests are often done with special machines into which the person must breathe.

• Blood tests. These can be used to check the amount of carbon dioxide and oxygen in the blood, evaluate liver and kidney function, and look for infection and other diseases.

• Bronchoscopy. A long, thin, flexible tube (bronchoscope) with a light at the end is put down the throat and into the lungs. This lets the doctor to view the bronchi, the main airways of the lungs. It is done to help evaluate and diagnose lung problems. Lung tissue samples (biopsies) and lung washings (lavage) that remove cells from the lungs can be done through the tube.

• Bronchoalveolar lavage. A sterile saline solution is put into the lungs through a bronchoscope and then suctioned out. The saline carries out cells from the lower respiratory tract. These cells can be checked under a microscope to help find inflammation and infection. The test can help rule out certain causes.

• Lung biopsy. A small piece of tissue, cells, or fluid from the lungs is taken out and checked under a microscope.

Sarcoidosis is often diagnosed when other lung disorders are ruled out.

Treatment is generally done to control symptoms and improve the function of organs affected by the disease. Steroid medicine such as prednisone may help reduce inflammation. It can be taken by mouth or inhaled. Other medicines, such as methotrexate, may be used in severe cases or if steroids don’t work.

In many cases, no treatment is needed for pulmonary sarcoidosis. Different treatments work better for different people. Sometimes more than one treatment is used. Most medicines used to treat sarcoidosis suppress the immune system.

You may also join a rehab program that includes education, exercise, and support. In severe cases, which are not common, oxygen therapy and even a lung transplant may be needed.