PO119 - Clinical bronchial hypersensitivity in sarcoidosis - more significant than we think?
Julia Rutkowska (Poland)1; Patrycja Nejman-Gryz (Poland)1; Anna Goljan-Geremek (Poland)1; Elżbieta Puścińska (Poland)2; Małgorzata Kobylecka (Poland)3; Joanna Żuchowska (Poland)4; Patrycja Roguska (Poland)5; Magdalena Dąbrowska (Poland)5; Maria Kaczorowska-Małek (Poland)1; Marta Maskey-Warzęchowska (Poland)1; Rafał Krenke (Poland)1;
1 - Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; 2 - 2nd Dept of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland; 3 - Department of Nuclear Medicine The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland; 4 - Second Department of Clinical Radiology Medical University of Warsaw, Warsaw, Poland; 5 - Students’ Scientfic Association “Alveolus”, Medical University of Warsaw, Poland;
Keywords: bronchial hyperresponsiveness; sarcoidosis; ICS;
Select the theme: Controversies in Sarcoidosis Treatment
Type: Original Papers
Presentation: Poster Presentation

Introduction: Bronchial hyperresponsiveness (BHR) in sarcoidosis may exacerbate respiratory symptoms resulting in overestimation of the severity of sarcoidosis and, in consequence, overtreatment with immunosuppressive agents.

Objectives: The aim of the study was to assess the prevalence and the characteristics of BHR symptoms in patients with sarcoidosis.

Materials and Methods: This study was part of a larger project comparing clinical sarcoidosis phenotypes with PET-CT phenotypes. From this cohort, a subgroup of 80 patients who had undergone high-quality pulmonary function tests (PFTs) was identified. For analytical purposes, these 80 patients were subsequently divided into three groups. Group 1 included patients with symptoms typical for BHR (cough, wheezing that varies over time and worsens during exertion), reversible airway obstruction and subjective improvement after ICS. Group 2 included patients who presented with the same symptoms and improvement after ICS, without confirmed reversible airway obstruction. Group 3 did not manifest any clinical symptoms suggestive of BHR. We compared groups 1+2 vs. 3 and group 1 vs. 3.

Results: There were 8 (10%), 9 (11,3%) and 63 (78,7%) in groups 1, 2 and 3, respectively. Patients with BHR symptoms (group 1+2) were older (56 vs 48), had longer sarcoidosis duration, and were statistically more likely to have allergies, allergic rhinitis, and family history of asthma compared to group 3. None of the patients in group 1 or 2 had eosinophilia, however group 1 had a lower neutrophil-to-lymphocyte ratio (NLR) than group 3 (1.76 (1.33 - 2.64) vs. 2.87 (2.00 - 4.55), p=0.036). No differences were found in prevalence of extrapulmonary sarcoidosis or pulmonary metabolic activity in PET-CT.

Conclusions: Approximately 20% of patients with sarcoidosis exhibit clinical symptoms of BHR. To avoid unnecessary escalation of immunosuppression, ICS should be used to treat BHR symptoms. In patients with sarcoidosis and BHR symptoms, the coexistence of asthma should be considered.