It is in this context that the study by Barnett and colleagues14 in this issue of CHEST (see page 1455) is a welcome addition to the literature. Using a retrospective design, they report on 22 patients with sarcoidosis-associated PAH who were treated with various PH-targeted therapies and were followed up for a median duration of 11 months. The authors showed an increase in the distance walked in 6 min, particularly in those patients with less severe restrictive lung defects, and reductions in pulmonary artery pressure as well as pulmonary vascular resistance. Despite these benefits, the 3-year transplant-free survival rate was only 74%. While contributing the largest of such series, the study by Barnett et al14 still has the usual deficiencies of a retrospective design, with the most important in this case being selection bias. Patients entered the study not by means of a standardized approach to identify PH, but merely by the fact that they were treated with pulmonary vasodilators. Furthermore, treatment decisions as to what constituted appropriate immunosuppression, which vasodilator to use, and when to use combination therapy were entirely arbitrary. Hence, the study lacks external generalizability and does not provide information about which patients to treat with pulmonary vasodilators or what specific therapies are best. As the authors appropriately acknowledge, their study mainly sparks the need for prospective randomized, controlled trials. Currently, there is one trial being conducted (ClinicalTrials.gov identifier NCT 00581607) assessing the use of bosentan. Future trials may benefit from information generated by Barnett and colleagues,14 which suggests that patients with lesser degrees of restrictive lung disease may derive the most benefit from vasodilator therapy.