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Prednisone Improves Symptoms but not Lung Function in Sarcoidosis.: Presented at CHEST

By Alison Palkhivala
Special to DG News

PHILADELPHIA, PA -- November 9, 2001 -- The use of oral prednisone reduces symptoms of dyspnea in patients with sarcoidosis affecting the lungs, but it does not have an impact on pulmonary function.

According to Natesa P Shanmugam, MBBS, a private practice physician in Washington DC, United States, "sarcoidosis is rare when you look at the general population, but amongst minorities the disease is a lot more common. It can affect virtually every organ, and the cause is not known. It predominantly involves the lungs and over the years can lead to respiratory failure in 20 to 30 percent of patients."

While working in the pulmonary critical care unity of the DC General Hospital, Dr. Shanmugam and colleagues set out to determine whether prednisone, which is given to patients with sarcoidosis for lack of any other therapeutic options, is actually helpful for this indication. He presented their findings here this week at the annual meeting of the American College of Chest Physicians (ACCP).

The investigators retrospectively reviewed the records of 68 patients with sarcoidosis, all African American, treated at their clinic for at least six months. 26 patients had radiographic stage 0 to 3 of the disease, and 42 had radiographic stage 4.

Six months of treatment with prednisone resulted in improvements in the symptoms of dyspnea in 43 patients (63 percent) but had no effect on vital lung capacity (VLC) or diffuse lung capacity (DLC). In 35 patients who were followed for a mean of 3.8 years, 22 (63 percent) also had improvements in dyspnea. VLC declined by a mean of 80 ml per year and DLC improved by a mean of .83 ml/min/mmHg per year, but neither of these changes were significant. Changes in angiotensin converting enzyme levels did not correlate with changes in symptoms, VLC, or DLC.

An additional comparative analysis of ten patients on methotrexate plus prednisone treatment and ten patients on prednisone alone revealed no differences between the two groups with respect to dyspnea or lung function, after controlling for age, sex, radiographic stage and lung function, after six months.

"Our conclusion is that dyspnea improves, [but] lung function does not get better," said Dr. Shanmugam. "… Something is getting better because people are feeling better. What it is, I don't know. [Prednisone should still be prescribed in symptomatic patients with sarcoidoisis because,] there are no other drugs in the pipeline [for this disease]."

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