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The impact of gas exchange measurement during exercise in pulmonary sarcoidosis.
MedLine Citation:
PMID:  20926272     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Pulmonary sarcoidosis shows a remarkable heterogeneity of phenotypes ranging from bihilar lymphadenopathy to progressive fibrosis. Individual disease assessment is demanding and requires sensible, practical measures. We tested whether gas exchange measurements during exercise reflects disease activity and clinical course in sarcoidosis.
METHODS: In 149 patients with proven pulmonary sarcoidosis the alveolar-arterial oxygen pressure gradient (P(A-a)O(2)) during exercise was assessed and compared with chest X-ray typing, pulmonary function, single breath-diffusing capacity for carbon monoxide (DL(CO)), serological markers, cell composition of bronchoalveolar lavage fluid (BALF) and clinical course. Patients were categorized according to thresholds of P(A-a)O(2) during exercise.
MEASUREMENTS AND MAIN RESULTS: Chest X-ray typing, pulmonary function, DL(CO) and the need for immunosuppressive treatment differed between the disease categories based on P(A-a)O(2) during exercise (p < 0.0001 each). Patients with an impairment of gas exchange during exercise also showed elevated levels of neopterin (p = 0.002) and higher percentages of neutrophils (p = 0.013) and eosinophils (p < 0.0001) in BALF. Multivariate regression analysis showed that forced vital capacity (FVC) (p = 0.009) and P(A-a)O(2) during exercise (p < 0.0001) were independently associated with a prolonged need for immunosuppressive treatment (>1 year), but not DL(CO). About 50% (n = 75) of the study population showed a normal spirometry. Even in this subgroup 23% had an impaired gas exchange during exercise, which correlated with chest X-ray types (p < 0.0001) and the need for immunosuppressive treatment (p < 0.005).
CONCLUSIONS: Impaired gas exchange during exercise reflects disease activity and its extent and is associated with a prolonged need for immunosuppressive treatment during follow-up in patients with pulmonary sarcoidosis.
Florian Kollert; Barbara Geck; Rolf Suchy; Rudolf A Jörres; Michael Arzt; Dominic Heidinger; Okka W Hamer; Antje Prasse; Joachim Müller-Quernheim; Michael Pfeifer; Stephan Budweiser
Publication Detail:
Type:  Journal Article     Date:  2010-10-06
Journal Detail:
Title:  Respiratory medicine     Volume:  105     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  122-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
Department of Internal Medicine II, Division of Pneumology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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