(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Sarcoidosis

Topics: Azathioprine; Beclomethasone; Diagnosis, Differential; Glucocorticoids; Humans; Immunosuppressive Agents; Lung Diseases; Recurrence; Sarcoidosis; Triamcinolone Acetonide; Tuberculosis, Pulmonary

Sarcoidosis is a chronic multisystem granulomatous disease that has a predilection for pulmonary and upper respiratory tract involvement. Because the initial signs and symptoms of sarcoidosis may be identical to those of other forms of chronic sinonasal inflammatory disease, these patients will often first seek treatment from an otolaryngologist. We present a series of 28 patients whose primary symptoms was involvement of a sinonasal tract. A new staging system is proposed to categorize the severity and sites of involvement and to guide the aggressiveness of therapy. Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease.

Topics: Adult; Beclomethasone; Chronic Disease; Constriction, Pathologic; Diagnosis, Differential; Edema; Epistaxis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasal Obstruction; Nose Deformities, Acquired; Nose Diseases; Paranasal Sinus Diseases; Prednisone; Sarcoidosis; Tissue Adhesions; Triamcinolone Acetonide

In a first chapter the author reviews the mechanisms of action of corticoids in respiratory diseases. Moreover the causes and the prevalence of unwanted side-effects are discussed. The advantages of synthetic glucocorticoids with short half-life time in pneumology are stressed. In the following chapters, the rationale of long-term corticoid treatments of asthma, in non allergic obstructive chronic lung diseases, in sarcoidosis and in the thoracic localisations of some collagen diseases is presented in detail. Regarding the treatment of asthma the author discusses the advantages of the alternate-day therapy, the use of corticoids in aerosols and the ratioale of ACTH. The usefulness of alternate-day therapy in sarcoidosis is also advocated.

Topics: Adrenocorticotropic Hormone; Aerosols; Asthma; Beclomethasone; Bronchitis; Chemical Phenomena; Chemistry; Chronic Disease; Collagen Diseases; Glucocorticoids; Humans; Lung Diseases, Obstructive; Respiratory Tract Diseases; Sarcoidosis; Time Factors

Nasosinusal Sarcoidosis is an uncommon entity setting forth diagnostical and therapeutical questions to be answered. The AA. report a case of the sort with simultaneous pathological involvement of the skin, without systemic manifestations. The disease showed as a mucopurulent scaly rhinitis. The maxillary sinus was stuffed with sarcoid tissue. Both topical and systemic treatment with corticoid drugs failed to bring nasal and sinusal lesions to lessening. The skin changes unfolded favourably.

Topics: Beclomethasone; Biopsy; Female; Humans; Lymphocytes; Maxillary Sinus; Middle Aged; Nasal Mucosa; Prednisone; Radiography; Reticulin; Sarcoidosis; Skin; Skin Tests; Treatment Outcome

In a consecutive series of 113 cases of biopsy - proven sarcoidosis from Eastern India (1972-1986), steroid aerosols were used in 345 episodes, either alone or with one of the non-steroidal anti-inflammatory drugs (and added chloroquin) or with oral steroids. These, being analysed in detail, revealed satisfactory results only when used with other drugs. Used alone, its role is limited due to high cost, absence of systemic action unless used in high dosage, "hand to lung" delivery problem and difficulty of using in children. It is unsuitable in cases with life - threatening symptoms, neurological or cardiac problems. If used judiciously with suitable companion drugs, it can be used very effectively and can replace oral steroids in many patients.

Topics: Administration, Inhalation; Anti-Inflammatory Agents, Non-Steroidal; Beclomethasone; Chloroquine; Drug Therapy, Combination; Humans; India; Prospective Studies; Sarcoidosis

Topics: Alveolitis, Extrinsic Allergic; Asthma; Beclomethasone; Bronchitis; Humans; Hydrocortisone; Lung Neoplasms; Prednisolone; Pulmonary Eosinophilia; Pulmonary Fibrosis; Respiratory Tract Diseases; Sarcoidosis; Steroids; Tuberculosis, Pulmonary

Emphysema, chronic bronchitis, asthma, and cystic fibrosis are often cited as examples of chronic airways obstruction, while sarcoidosis is typically restrictive. Approximately 15 percent of sarcoidosis patients, however, have airways obstruction clinically characterized by wheezing with granulomatous involvement of airways. Since the majority have Stage IV disease by chest radiograph, their lungs usually have honey-combining with pulmonary fibrosis, adhesions, cavities, and mediastinal distortion.Patients had a mixed ventilatory defect, but obstruction of large airways was present as shown by decreased specific airways conductances. Small airways obstruction was also present as shown by low instantaneous flows at the terminal portion of the maximum expiratory flow-volume curve and diminished helium response of this curve. The closing volume, however, was not very sensitive. Radioactive xenon washout from ventilation lung scans and N2 washout from the lungs were prolonged in patients with worse disease.The authors conclude that the obstructive type of physiologic pattern is more frequent than recognized in sarcoidosis, which like that of cystic fibrosis has some restrictive element and is characterized by poor reversibility to bronchodilators. A trial period of beclomethasone dipropionate aerosol was not helpful in two patients. Relief of this distressing airways obstruction continues to pose a challenging problem in management.

Topics: Adult; Airway Obstruction; Beclomethasone; Bronchodilator Agents; Female; Humans; Male; Respiratory Function Tests; Sarcoidosis; Smoking