tag:blogger.com,1999:blog-12660458.post114011369215417708..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: Progressive Disease?Unknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-12660458.post-1140125883288493152006-02-16T16:38:00.000-05:002006-02-16T16:38:00.000-05:00That former fellow (along with a current professor...That former fellow (along with a current professor emeritus) had the pathology reviewed here. It was confirmed as sarcoidosis. As for the now, the patient is otherwise asymptomatic and has had no complaints suggestive of infection...<BR/><BR/>I will leave the discussion open for now, as I'm interested to hear what more people have to say, and then let you all know what I actually did....Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1140123432876902052006-02-16T15:57:00.000-05:002006-02-16T15:57:00.000-05:00Well, for starters, I wouldn't trust anything that...Well, for starters, I wouldn't trust anything that first fellow said... But back to the current problem. I think the major difficulty is differentiating the asthma/bronchospasm from the progression of the sarcoid.<BR/>The decision to treat is not so obvious here because of the improvement. If we believe this is mostly bronchospasm (with the good response to ICS) you could make an argument to close short term follow-up since the patient has “asymptomatic” progression of sarcoid. Conversely, I don’t think you would be at fault for trying some steroids: she has had worsening respiratory symptoms with a decline in PFTs in the setting of radiographic progression.<BR/>I would also consider a bronch. It seems like it is also sarcoid but just because that fellow thought it was sarcoid a few years ago it doesn’t mean she has the same process. She may also have a chronic infection complicating the picture.Baleeirohttps://www.blogger.com/profile/03993066135160692535noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1140119932930050972006-02-16T14:58:00.000-05:002006-02-16T14:58:00.000-05:001)Would one treat for radiographic progression of ...1)Would one treat for radiographic progression of Stage 4 sarcoidosis in the absence of a decline in pulmonary function?<BR/><BR/>Depends on what you see radiographically. It seems from your description that there are some "reversible" changes (i.e. changes that are not scarred), I would consider it. Hydroxychloroquine would be a reasonable drug if she is against immunosuppressives. <BR/><BR/>However, your PFT's do not show any changes in 5 years (other than the one blip), so it would also be reasonable to watch Spiro and a DLCO every 3 months to observe any trends.<BR/><BR/>2)Do you think that the persistent "band-like" chest tightness is related to either her sarcoidosis or to asthma? <BR/><BR/>I have seen some patients like this, and I believe that it is secondary to altered pleural anatomy. Patients get some lung parenchyma scarring, and it causes some "tugging" on the parietal pleura which is perceived as pain. If it worsens when the patient gets a respiratory infection, it is almost certainly this entity. <BR/>I presume, of course, that you have ruled out other sources (cardiac, etc).Mike Lhttps://www.blogger.com/profile/12177750268091750583noreply@blogger.com