Guidelines for the use of corticosteroids in the treatment of pulmonary sarcoidosis.

Sarcoidosis is the most common diffuse parenchymal lung disease and occurs worldwide. Although it affects all ethnic groups, prevalence and severity varies between different races. This has complicated the interpretation of existing clinical studies and extrapolation of their findings to different populations. Sarcoidosis can affect any organ, but the lungs are involved in >90% of patients, and respiratory specialists are therefore frequently responsible for their care. Oral corticosteroids have been used to treat sarcoidosis since the 1950s, with evidence of short- to medium-term improvement in symptoms, respiratory function and radiology. More recently, there have been studies examining the role of inhaled corticosteroids. The long-term benefits of corticosteroid treatment are nevertheless uncertain. Current international guidelines (published in 1999) on sarcoidosis, including recommendations on treatment, represent a consensus statement endorsed by North American and European respiratory societies. British guidelines on diffuse parenchymal lung disease, including sarcoidosis, were published in the same year. There are clearly areas where there is agreement and others where uncertainty persists. This article outlines current guidance with particular reference to which patients should be treated, when treatment should be commenced, the possible role of inhaled corticosteroids, how long treatment should be continued, and what monitoring should be performed for adverse events.