Frequency of acute worsening events in fibrotic pulmonary sarcoidosis patients.

Patients with fibrotic sarcoidosis can develop worsening of pulmonary symptoms for various reasons. We studied acute worsening events defined as episodes treated with limited courses of either antibiotics and or increased corticosteroid doses which resolved within four weeks. The prevalence of acute worsening events in patients with fibrotic sarcoidosis was investigated. Of 740 sarcoidosis patients seen in our clinic over a four month period, 129 (17%) had fibrotic sarcoidosis. We noted the age, race, gender, computer tomography (CT) results, and pulmonary function as measured by forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio. In a retrospective manner, the fibrotic sarcoidosis patients reported a median of three acute worsening events (range zero to eight) in the prior year. Bronchiectasis was noted on CT imaging in 63 of 129 (49%) of the fibrotic sarcoidosis patients. Fibrotic sarcoidosis patients reported a higher frequency of acute worsening events (3 (0-6)) than those without bronchiectasis (2 (0-8), p = 0.0001). Sixteen patients receiving anti-tumor necrosis factor antibodies reported a higher frequency of acute worsening events compared to those not receiving anti-tumor necrosis factor antibodies (p = 0.0297). There was no relationship between the number of acute worsening events and race, gender, smoking history, or FVC, FEV1, or FEV1/FVC ratio. We conclude that acute worsening events are frequent in patients with fibrotic sarcoidosis patients and are more common in patients with bronchiectasis and those receiving anti-tumor necrosis factor antibody therapies.