The alveolitis of pulmonary sarcoidosis. Evaluation of natural history and alveolitis-dependent changes in lung function

Journal Article · Mon Aug 01 04:00:00 EDT 1983 · Am. Rev. Respir. Dis.; (United States)

OSTI ID:5477728

Keogh, B A; Hunninghake, G W; Line, B R; Crystal, R G

Current concepts of the pathogenesis of pulmonary sarcoidosis suggest that a mononuclear cell alveolitis, comprised of activated T-lymphocytes and activated alveolar macrophages, precedes and modulates the formation of granuloma and fibrosis. To evaluate the natural history of this alveolitis and determine the relationship it has to subsequent changes in lung function, 19 untreated patients with pulmonary sarcoidosis without extrapulmonary manifestations were studied with bronchoalveolar lavage, /sup 67/Ga scanning, and pulmonary function tests to evaluate lung T-cells, lung alveolar macrophages, and lung function, respectively. In patients with sarcoidosis, low intensity alveolitis (lung T-cells less than or equal to 28% of all lung effector cells and/or /sup 67/Ga scan negative) was much more common (80% of all observations) than high intensity alveolitis (lung T-cells greater than 28% and /sup 67/Ga scan positive, 20% of all observations). Conventional clinical, roentgenographic, or physiologic studies could not predict the alveolitis status. Interestingly, of the 51 alveolitis evaluations in the 19 patients, there were 24 occurrences (47%) where the alveolitis was ''split,'' i.e., /sup 67/Ga scans positive and T-cells low (39%) or /sup 67/Ga negative and T-cells high (8%). Most untreated patients with sarcoidosis without extrapulmonary symptoms may have some inflammatory processes ongoing in their alveolar structures. Overall, whenever a high intensity alveolitis episode occurred, it was followed by deterioration over the next 6 months in at least one lung function parameter. A low intensity alveolitis episode was followed by functional deterioration only 8% of the time. The alveolitis parameters (lavage and /sup 67/Ga scanning) clearly predicted prognosis. These observations should prove useful in understanding the natural history of pulmonary sarcoidosis, in staging patients with this disease, and in making rational therapy decisions.

• Research Organization: Pulmonary Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland
• OSTI ID: 5477728
• Journal Information: Am. Rev. Respir. Dis.; (United States), Journal Name: Am. Rev. Respir. Dis.; (United States) Vol. 128:2; ISSN ARRDA
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
ANIMAL CELLS
ANIMAL TISSUES
BETA DECAY RADIOISOTOPES
BIOLOGICAL MATERIALS
BIOMEDICAL RADIOGRAPHY
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
CONNECTIVE TISSUE CELLS
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DIAGNOSTIC TECHNIQUES
DISEASES
ELECTROMAGNETIC RADIATION
ELECTRON CAPTURE RADIOISOTOPES
GALLIUM 67
GALLIUM ISOTOPES
INFLAMMATION
INTERMEDIATE MASS NUCLEI
IONIZING RADIATIONS
ISOTOPES
LAVAGE
LEUKOCYTES
LUNGS
LYMPHOCYTES
MACROPHAGES
MATERIALS
MEDICINE
NUCLEAR MEDICINE
NUCLEI
ODD-EVEN NUCLEI
ORGANS
PATHOGENESIS
PATHOLOGICAL CHANGES
PATIENTS
PHAGOCYTES
RADIATIONS
RADIOISOTOPE SCANNING
RADIOISOTOPES
RADIOLOGY
RESPIRATORY SYSTEM
RESPIRATORY SYSTEM DISEASES
RETICULOENDOTHELIAL SYSTEM
SCINTISCANNING
SOMATIC CELLS
STIMULATION
SYMPTOMS
TISSUES
X RADIATION