fluticasone and Sarcoidosis--Pulmonary

Inhaled corticosteroids have been used with variable success in sarcoidosis. The role of the inhaled corticosteroid fluticasone in symptomatic pulmonary patients was studied.. Twenty-two patients at five institutions who had been given an initial dose of oral corticosteroids within the prior four weeks were enrolled in a randomized double blind trial of inhaled fluticasone. An algorithm for the dosage of prednisone including rules for reducing dose was developed and applied at all centers.. Of the 21 patients seen for more than one visit, 10 received fluticasone and 11 placebo. There was no significant difference in the improvement of vital capacity or average daily dose of prednisone for the fluticasone versus placebo. Eight of ten patients taking fluticasone had improvement in cough, while only 6 of 11 patients on placebo had improved cough despite taking oral corticosteroids (p = 0.36, N.S.). The algorithm for decreasing corticosteroid dosage was exactly applied in over 80% of patient visits and oral corticosteroids were used throughout most of the year of treatment. Patients registered higher complaints regarding increased appetite and polyuria when on ten mg or more prednisone a day. There was no clinical difference in the rate of toxicity for the fluticasone versus placebo group.. A standard approach to tapering oral corticosteroids was followed in over 80% of patient visits. Oral corticosteroids were associated with significant complaints, while inhaled corticosteroids were well tolerated.

Topics: Acute Disease; Administration, Inhalation; Administration, Topical; Adult; Androstadienes; Anti-Inflammatory Agents; Double-Blind Method; Female; Fluticasone; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Middle Aged; Sarcoidosis, Pulmonary; Vital Capacity

Pulmonary sarcoidosis is a disease in which the pathological processes are distributed along lymphatic pathways, particularly those around the bronchovascular bundles. Delivery of disease-modulating drugs by the inhaled route is therefore an attractive option. The aim of this study was to determine the efficacy of inhaled fluticasone propionate 2 mg x day(-1) in adults with stable pulmonary sarcoidosis. Forty-four adult patients (22 from each centre) were enrolled from outpatient clinics in two London teaching hospitals in a two centre, double-blind, randomized, placebo-controlled trial. Primary end points were home recordings of peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). Secondary end points were symptom scores, use of rescue bronchodilator medication, and clinic values for PEFR, FEV1, FVC, forced mid-expiratory flow (FEF25-75%), diffusion capacity of the lung for carbon monoxide (DL,CO), and total lung capacity (TLC). Symptom scores of cough, breathlessness and wheeze were lower in the active treatment group, but this did not reach statistical significance, and a general health perception assessment (Short Form (SF)-36) showed a difference between active and placebo treatment. No significant differences were found between the two groups in any physiological outcome measure. No new adverse reactions were detected. The results of this pilot study do not show an objective benefit of inhaled fluticasone propionate in pulmonary sarcoidosis where the disease is stable and is controlled without the use of inhaled corticosteroids.

Topics: Administration, Inhalation; Administration, Topical; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Double-Blind Method; Female; Fluticasone; Forced Expiratory Volume; Glucocorticoids; Humans; Male; Maximal Expiratory Flow Rate; Middle Aged; Peak Expiratory Flow Rate; Pilot Projects; Pulmonary Gas Exchange; Sarcoidosis, Pulmonary; Vital Capacity

A rare case of sarcoidosis is presented. A 32-year-old white woman initially diagnosed with asthma was to undergo thyroidectomy to eliminate what was thought to be the real source of her symptoms. Instead, the cause was found to be sarcoidosis involving only the major airways, without intrathoracic adenopathy, atelectasis, pulmonary parenchymal infiltrates or evidence of extra pulmonary disease. She rapidly responded to systemic glucocorticoids, which later was supplemented successfully by inhaled glucocorticoids for persistent cough.

Topics: Adult; Androstadienes; Asthma; Bronchoscopy; Diagnosis, Differential; Female; Fluticasone; Follow-Up Studies; Glucocorticoids; Goiter; Humans; Radiography, Thoracic; Respiratory Function Tests; Sarcoidosis, Pulmonary; Thyroidectomy; Tomography, X-Ray Computed; Treatment Outcome

Topics: Androstadienes; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; Bronchodilator Agents; CD4-CD8 Ratio; Diagnosis, Differential; Female; Fluticasone; Humans; Lymphocyte Count; Middle Aged; Sarcoidosis, Pulmonary; Sputum; Uveitis, Anterior