Diffuse Lung Disease |

Patterns of Pulmonary Function Test (PFT) Abnormalities in Sarcoidosis FREE TO VIEW

Ameer Rasheed*, MD; Viswanath Vasudevan, MD; Farhad Arjomand, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2012;142(4_MeetingAbstracts):446A. doi:10.1378/chest.1389741
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: A variety of PFT abnormalities are described in sarcoidosis. Lung restriction is typically characterized by reduced TLC, VC, and DLCO. ATS/ERS defines restistion as reduction in TLC < LLN of 95% CI of NHANES-II derived reference values. However, TLC is measured only in pulmonary physiology laboratory. Spirometry is accessible and measures only vital capacity and air flow limitation. We sought to define prevalence of PFT abnormalities in Sarcoidosis and correlation between TLC and VC.

METHODS: A 400 bed University affiliated hospital in northern B’klyn, NYC. PFT data of all patients with sarcoidosis was reviewed. PFT findings were categorize in three groups; Obstructive, restrictive and obstructive-restrictive.

RESULTS: Of 142 patients; 100 (70%) were females and 42 (30%) were males with median age of 45 years (range, 18-81). Based on imaging studies patients were categorized as Normal (Stage-0) -18; Bilateral thoracic adenopathy (stage 1) - 24; parenchymal opacities+ adenopathy (stage-II) - 42; parenchymal opacities (stage -III) - 44. CXR was not available in 8 patients. 78/142 (55%) had restriction (low VC and/or TLC). Both TLC and VC were reduced in 31/78 (38%); There was discordance in reduction in TLC and VC in 47/78 (62%); 42 had low TLC but normal VC; while 5 had low VC but normal TLC. Obstruction was noted in 34 (24%) patients; 6/34(18%) had reversibility. 16/142 (11%) had combined obstruction-restriction. The DLCO was reduced in 110/142(77%); 15% had isolated decrease in DLCO and 23/142(16%) had normal PFT including DLCO.

CONCLUSIONS: Correlation between VC and TLC in sarcoidosis is poor and there is no set pattern. DLCO is the most sensitive parameter, followed by reduced TLC and then VC. In symptomatic patients the entire PFT pattern (VC, TLC and DLCO) should be considered in the interpretation of restrictive ventilatory defect to avoid missed diagnosis and therapy.

CLINICAL IMPLICATIONS: In symptomatic patients, it is critical to do the full PFT including static Lung volume measurement and Diffusion capacity. Spirometry alone will underdiagnose severity of PFT impairment.

DISCLOSURE: The following authors have nothing to disclose: Ameer Rasheed, Viswanath Vasudevan, Farhad Arjomand

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The Brooklyn Hospital Center, Brooklyn, NY




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