Robert B. Teague

Serial changes in markers of disease activity with corticosteroid treatment in sarcoidosis

Serial changes in various markers of disease activity with corticosteroid therapy were assessed in 12 patients with active sarcoidosis. After six weeks of treatment with 40 mg daily of prednisone, all but one patient demonstrated symptomatic and radiographic improvement. For the entire patient group, there were corresponding improvements in forced vital capacity, from 59.2 +/- 5.5 to 70.5 +/- 5.3 percent of the predicted value (p less than 0.001, Student paired t test), serum angiotensin-converting enzyme levels, from 66.0 +/- 12.1 to 28.2 +/- 4.0 U/ml (p = 0.003), 67gallium lung scanning scores, from 3.6 +/- 0.2 to 0.8 +/- 0.3 (p less than 0.001), serum gamma globulin levels, from 2.40 +/- 0.2 to 1.5 +/- 0.1 g/dl (p less than 0.001), and erythrocyte sedimentation rate, from 26.8 +/- 2.7 to 14.8 +/- 3.0 mm per hour (p less than 0.001). Changes in percent of bronchoalveolar lavage fluid lymphocytes were less impressive (from 28.7 +/- 4.9 to 21.2 +/- 5.1, p = 0.034), but the geometric mean number of bronchoalveolar lavage fluid-IgG-secreting cells decreased from 23,861 to 3,830 (p = 0.013). Serial evaluations in five patients treated with decreasing doses of alternate-day prednisone for an additional 10 1/2 months indicated that changes in 67gallium lung scanning scores corresponded most closely to the clinical course in five of five patients. Determination of serum angiotensin-converting enzyme levels also closely paralleled the clinical course in four of five patients, whereas the other parameters measured were more variable markers of clinical response. However, abnormalities of bronchoalveolar lavage fluid-IgG-secreting cells often persisted in the absence of clinically evident disease, and the percentages of bronchoalveolar lavage fluid lymphocytes were frequently normal in patients who responded subsequently to corticosteroids. Larger prospective studies are warranted to more extensively evaluate various measurements of disease activity, especially bronchoalveolar lavage fluid analysis, in sarcoidosis.

Cigarette Smoking and Bronchoalveolar T Cell Populations in Sarcoidosis

Pulmonary physicians must often deal with patients, including patients with sarcoidosis, who smoke cigarettes. Since changes in local pulmonary immune function have been associated with both sarcoidosis’4 and cigarette smoking;-’o it is important to distinguish which of these immunological changes in the lungs are due to the disease, which are due to cigarette smoking, and which, perhaps, are due to both. Abnormally large numbers of helper thymus-derived (T) lymphocytes are found in fluids recovered by bronchoalveolar lavage (BAL) from patients with sarcoidosis.“ By contrast, normal numbers of lymphocytes are found in BAL fluids from normal cigarette smokers,6 and lower than normal percentages of the cells in these fluids are lympho~ytes .~*~~’~ The effects of smoking on T lymphocyte subpopulations in normal cigarette smokers and on those in patients with sarcoidosis, however, have not been thoroughly characterized. The purposes of this study, therefore, were 1) to determine the effects of smoking on T lymphocyte subpopulations in BAL fluids from healthy normal volunteers (“normals”) and on those in BAL fluids from patients with sarcoidosis ((‘sarcoids”), and 2) to determine whether comparisons of the T lymphocyte subpopulations of normals and those of sarcoids revealed any effects of cigarette smoking.