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Communications to the Editor |

Endobronchial Sarcoidosis and Hyperreactive Airways Disease FREE TO VIEW

Gene R. Pesola, MD, MPH; Mostafa Kurdi, MD; Margaret Olibrice, MD, FCCP
Author and Funding Information

Affiliations: Harlem Hospital/Columbia University New York, NY,  Walter Reed Army Medical Center Washington, DC

Correspondence to: Gene R. Pesola, MD, MPH, Department of Pulmonary/Critical Care Medicine, Harlem Hospital/Columbia University, MLK-14101, 506 Lenox Ave, New York, NY 10037; e-mail: grp4@columbia.edu



Chest. 2002;121(6):2081. doi:10.1378/chest.121.6.2081
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To the Editor:

We read with interest the article by Shorr et al (September 2001),1 regarding the hyperreactive airway response (AHR) seen in the subgroup of nonsmoking patients with newly diagnosed sarcoidosis and endobronchial disease. Although the data are limited,1(Table 1) if sarcoidosis is a given, the probability of the test (endobronchial biopsy) for diagnosing sarcoidosis approaches one if the patient has AHR with no other obvious etiology for AHR. In nonsmoking subjects who present with abnormal chest radiographic findings compatible with stage I sarcoidosis, the probability of getting an endobronchial biopsy compatible with sarcoidosis is about 50% if the patient eventually is found to have sarcoidosis.2Presumably, if the patients in that study also had AHR, the probability of making a diagnosis of sarcoidosis would increase even further, and the best way to do it might be by endobronchial biopsy if there are no external lesions to sample and the Kveim test was not available.34 If more data back up the claim that AHR in newly diagnosed sarcoidosis almost always guarantees a diagnosis of endobronchial sarcoid, then AHR can be added to the diagnostic approach in making a diagnosis of lung disease in subjects with nondiagnostic symptoms and other indicators suggestive of sarcoidosis.

In patients without a diagnosis with chest radiographic findings compatible with stage I sarcoidosis and AHR with no other cause, the leading diagnosis should probably be sarcoidosis until proven otherwise,5 assuming this preliminary study is correct. In this particular case scenario, the endobronchial biopsy would be of great value. We look forward to more studies validating the findings of Shorr et al.1

The opinions expressed herein are not to be construed as official or as reflecting the policy of either the Department of the Army or the Department of Defense.

Shorr, AF, Torrington, KG, Hnatiuk, OW (2001) Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis.Chest120,881-886. [PubMed] [CrossRef]
 
Freidman, OH, Blaugrund, SM, Siltzbach, LE Biopsy of the bronchial wall as an aid in diagnosis of sarcoidosis.JAMA1963;183,646-650. [PubMed]
 
Teirstein, AS The Kveim test after Siltzbach.Ann N Y Acad Sci1986;465,744-746. [PubMed]
 
Pesola, G, Teirstein, AS, Goldman, M Sarcoidosis presenting with pericardial effusion.Sarcoidosis1987;4,42-44. [PubMed]
 
Presas, FM, Colomer, PR, Sanchon, BR Bronchial hyperreactivity in fresh stage I sarcoidosis.Ann N Y Acad Sci1986;465,523-529. [PubMed]
 
To the Editor:

We appreciate the comments of Pesola and colleagues regarding our study of airway hyperreactivity (AHR) in patients with sarcoidosis.1In order to determine if endobronchial biopsy (EBB) should be performed during bronchoscopy for suspected sarcoidosis, they suggest that clinicians rely on the results of formal AHR testing. If AHR is present, they imply, then EBB would be useful. However, if AHR is absent, then EBB should be avoided. We disagree. First, the yield of EBB is high, irrespective of the presence or absence of AHR. As we showed in an earlier analysis2 of a diverse cohort of patients, EBB findings are positive in > 60% of subjects. More importantly, the addition of EBB to transbronchial biopsy increases the diagnostic yield of bronchoscopy by 20%. Second, EBB is safe and minimally increases the length of the procedure. This point is particularly important, since a more invasive and costly intervention such as mediastinoscopy might be required if a bronchoscopy is nondiagnostic. In short, the risk-benefit ratio associated with EBB favors employing this technique routinely in cases of suspected sarcoidosis.

References
Shorr, AF, Torrington, KG, Hnatiuk, OW Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis.Chest2001;120,881-886. [PubMed] [CrossRef]
 
Shorr, AF, Torrington, KG, Hnatiuk, OW Endobronchial biopsy for sarcoidosis: a prospective study.Chest2001;120,109-114. [PubMed]
 

Figures

Tables

References

Shorr, AF, Torrington, KG, Hnatiuk, OW (2001) Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis.Chest120,881-886. [PubMed] [CrossRef]
 
Freidman, OH, Blaugrund, SM, Siltzbach, LE Biopsy of the bronchial wall as an aid in diagnosis of sarcoidosis.JAMA1963;183,646-650. [PubMed]
 
Teirstein, AS The Kveim test after Siltzbach.Ann N Y Acad Sci1986;465,744-746. [PubMed]
 
Pesola, G, Teirstein, AS, Goldman, M Sarcoidosis presenting with pericardial effusion.Sarcoidosis1987;4,42-44. [PubMed]
 
Presas, FM, Colomer, PR, Sanchon, BR Bronchial hyperreactivity in fresh stage I sarcoidosis.Ann N Y Acad Sci1986;465,523-529. [PubMed]
 
Shorr, AF, Torrington, KG, Hnatiuk, OW Endobronchial involvement and airway hyperreactivity in patients with sarcoidosis.Chest2001;120,881-886. [PubMed] [CrossRef]
 
Shorr, AF, Torrington, KG, Hnatiuk, OW Endobronchial biopsy for sarcoidosis: a prospective study.Chest2001;120,109-114. [PubMed]
 
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