This man has biopsy proven sarcoid. His xray is shown here; it has not changed in 6 years. What has changed is his FEV1 which was 59% predicted in 2001 and is now 30% predicted. He has no shortness of breath or dyspnea on exertion AT ALL. He has a moderate cough. He is leary of steroids but will do what's best.
Would you "insist" on treatment?
4 comments - CLICK HERE to read & add your own!:
If it's a solid diagnosis of sarcoid, you've ruled out infection, and this is not a single point-in-time decrease in FEV1 but a consistent deterioration, I would very strongly recommend treatment. If there is a response to steroids, you can consider a transition to steroid-sparing agents like methotrexate or immuran down the line.
How old is the patient? If his pulmonary function fails to improve with treatment, he may be on the road to a transplant.
There are no values between 2001 (59% predicted) and 2006, but 2 separate PFT's last visit and visit a month or so ago both show 30% predicted.
I agree with you and I convinced the patient to go with steroid treatment. He's 61 years old. Transplant was raised to him as a possiblity if there is still deterioration. I told him there is not much "buffer" room below 30%...
You could also make the argument that his PFT's worsened between 2002 and 2003, for example. Then, he has stayed stable for at least 2 years.
In this case, I would only follow with serial PFT's.
It would not be unreasonable to wait 3 months and see how he does.
Alternatively, he could get better with steroids and lessen his morbidity/mortality related to the disease.
What Jeff H said. I would re-CT and look for infections and other treatable complications and then strongly consider treating the sarcoid.
Post a Commenttest post a comment