Clinical Question Do inhaled or o...

Clinical Question

Do inhaled or oral corticosteroids improve issues for patients with pulmonary sarcoidosis?

Evidence-Based Answer

Patients who take oral corticosteroids are more likely to indicate improvement in their chest radiographs than those taking placebo, although improvements in symptoms and lung function are les certain. The typical dosage used in randomized trials was 20 mg daily or 40 mg each two days tapered over several months

Practice Pointers

Sarcoidosis is a multisystem disease that frequently affects the lungs. Pulmonary sarcoidosis is characterized by dint of cough, breathlessness, and progressive respiratory failure. Corticosteroids are the mostly widely used treatment, but until now, the evidence had not been reviewed systematically. Other treatments, like as methotrexate, antimalarial drugs, cyclosporine (Sandimmune), and the immunomodulator infliximab (Remicade), have been les well studied. (1)

Paramothayan and associates establish 12 randomized controlled trials using different doses and passages of administering corticosteroids. only couple were double-blinded, and only pair used adequate concealment of allocation. The 1051 participants involved in the studies were at various stages of histology-confirmed disease. The studies used a variety of issues primarily symptoms, lung function, and chest radiograph findings. not many data were available for more than sum of two units years of follow-up, and none of the studies measured the impact in succession mortality. In general, studies were small, most numerous with fewer than 50 participants.

Four studies compared oral steroids with placebo, and sum of two units compared oral steroids with no treatment. of the brace largest studies, one used a tapering dose of 20 to 10 mg daily and the other a tapering dose of 40 to 20 mg each two days. The researchers originate a consistent benefit in confines of improved chest radiograph appearance at the finis of follow-up (70 versus 49 percent P = 04 number stand in want ofed to treat = 5). However, they rest no consistent evidence of symptomatic improvement or improvement in measures of lung function. Comparisons of inhaled steroids with placebo did not exhibit to any consistent benefit.

Paramothayan N et al. Corticosteroids for pulmonary sarcoidosis. Cochrane Database Syst Rev 2005;(2):CD001114

REFERENCES

(1) Baughman RP Lower EE du Bois RM Sarcoidosis. Lancet 2003;361: 1111-8

MARK H EBELL. MD MS

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