![]() There is increasing evidence that genetics play an important role in the pathogenesis, and certain HLA subtypes are associated with disease risk as well as clinical phenotype. It is postulated that there is an environmental trigger of the disease, which results in granulomatous inflammation with a predominance of T-cell helper lymphocytes. The cause of sarcoidosis is not well delineated. Fifty five percent of patient diagnosed with sarcoidosis are over 55 years of age at the time of diagnosis. There tends to be two peaks of incidence, one at about age 30 and another at about age 65, therefore, a large age range can be affected. In the U.S., the incidence of sarcoidosis is highest in females and African Americans but can be seen in all racial and ethnic groups. Highest rates occur in the Northeast, South and Midwest. There is significant regional variation in the prevalence of disease, so familiarity with the disease in certain locations is essential. The prevalence of sarcoidosis is increasing in the United States, with at least 185,000 patients seeking out medical care annually, so while it is considered an orphan disease, the prevalence of disease may be higher than currently appreciated. The ability to identify patients suffering from sarcoidosis provides an opportunity to improve both patient outcomes and decrease healthcare costs. PFTs can also provide evidence of worsening parenchymal disease in patients with symptoms that are unresponsive to treatment. Treatment of pulmonary sarcoidosis should be considered when patients have symptoms impairing quality of life or when the granulomatous inflammation causes progressive loss of pulmonary function, affects the heart, brain, kidneys, or causes hypercalcemia. Typical pulmonary symptoms include nonproductive cough and exertional dyspnea, and patients often report wheezing. However, PFTs are often performed as part of the initial evaluation of a sarcoidosis patient and can be helpful in phenotyping pulmonary sarcoidosis as well as evaluating for alternative diagnoses. PFTs are only a piece of a puzzle when diagnosing pulmonary sarcoidosis (including a consistent clinical presentation, imaging, and biopsy). Unfortunately, pulmonary function tests (PFTs) are not a reliable means for detecting the presence of pulmonary sarcoidosis, nor do they provide an accurate estimate of the extent of parenchymal disease. Patients are often left undertreated or misdiagnosed due to the diverse presentation of sarcoidosis, which can be further confounded by the numerous possible findings noted on Pulmonary Function Testing. The diagnosis of pulmonary sarcoidosis can be difficult. Sarcoidosis is a granulomatous inflammatory disease of unknown etiology that can affect any organ, but most commonly affects the lungs. The goal of this review is to discuss the patterns and pitfalls of PFT interpretation in patients with sarcoidosis. PFTs are one of many potentially useful tools when following patients with pulmonary sarcoidosis. Pulmonary function testing (PFT), along with chest imaging, is often the initial testing obtained by the respiratory physician in evaluation of the patient with dyspnea and is often used to monitor response to therapy. Unfortunately, diagnosis can be complex and require significant testing. Identification of sarcoidosis patients is key to improving their outcomes and reducing health care costs. Sarcoidosis is a granulomatous disease of unknown etiology that can affect any organ.
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