Symptoms and treatment of sarcoidosis of the lungs. Pulmonary sarcoidosis (Besnier-Beck-Schaumann disease, Beck's Sarcoidosis) Pulmonary sarcoidosis 2nd stage treatment

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to be given to infants? How can you lower the temperature in older children? What medications are the safest?

morning (the patient has not yet got out of bed, but already feels tired);
daytime (you have to take frequent breaks in work for rest);
evening (intensifies in the 2nd half of the day);
chronic fatigue syndrome.

In addition to fatigue, patients may experience decreased appetite, lethargy, and apathy.

With the further development of the disease, the following symptoms are noted:

Sometimes (for example, with sarcoidosis of the intrathoracic lymph nodes) external manifestations of the disease are practically absent. The diagnosis is made by chance, when X-ray changes are detected.

Localization of sarcoidosis

Lungs and VGLU

Extrathoracic lymph nodes

Liver and spleen

Eyes

Diagnostics

Blood chemistry.
Radiography chest.
Mantoux test (to exclude tuberculosis).
Spirometry is a test of lung function using a special device.
Analysis of fluid from the bronchi taken using a bronchoscope - a tube inserted into the bronchi.
If necessary, a lung biopsy is performed - removing a small amount of lung tissue to study it under a microscope. The piece of tissue required for analysis is removed using a special (puncture) needle or bronchoscope.

Where to treat sarcoidosis?

Moscow Research Institute of Phthisiopulmonology.
Central Research Institute of Tuberculosis of the Russian Academy of Medical Sciences.
St. Petersburg Research Institute of Pulmonology named after. Academician Pavlov.
St. Petersburg Center for Intensive Pulmonology and Thoracic Surgery based at City Hospital No. 2.
Department of Phthisiopulmonology, Kazan State medical university. (A. Wiesel, the chief pulmonologist of Tatarstan, deals with the problem of sarcoidosis there).
Tomsk Regional Clinical Diagnostic Clinic.

Treatment

Since the specific cause of the disease has not been identified, it is impossible to find a medicine that could affect it.

non-steroidal anti-inflammatory drugs (Aspirin, Indomethacin, Diclofenac, Ketoprofen, etc.);
immunosuppressants (drugs that suppress the body’s immune reactions - Rezokhin, Delagil, Azathioprine, etc.);
vitamins (A, E).

All these medications are used in fairly long courses (several months).

For sarcoidosis of the eyes or skin topical hormonal drugs are prescribed ( eye drops, ointments, creams).

Treatment of sarcoidosis - video

Folk remedies

Herbal infusions

This collection includes the following herbs: nettle and St. John's wort (9 parts each), peppermint, calendula, chamomile, celandine, string, coltsfoot, cinquefoil, plantain, bird knotweed (1 part each). One tablespoon of the collection is poured into 0.5 liters of boiling water and left for 1 hour.

The resulting infusion is taken three times a day, 1/3 cup.

Mix the following herbs in equal parts: oregano, knotweed, sage, calendula flowers, marshmallow root, plantain. One tablespoon of the mixture is poured into a glass of boiling water and left for 0.5 hours in a thermos.

Take the same as in the previous recipe.

Shevchenko mixture

Beaver gland tincture

Take this remedy three times a day, 20 drops before meals. It is recommended to take bear or badger fat along with the tincture.

Propolis tincture

Diet for sarcoidosis

1. Sugar, flour and all dishes that include these products.

2. Cheese, milk, dairy products.

3. Table salt.

Forecast

Prevention

sufficient sleep;
good nutrition;
physical activity in the fresh air.

Reviews

please tell me how to treat, otherwise doctors don’t know how to treat.

Leave feedback

You can add your comments and feedback to this article, subject to the Discussion Rules.

Pulmonary sarcoidosis

Pulmonary sarcoidosis (synonyms Beck's sarcoidosis, Besnier-Beck-Schaumann disease) is a disease belonging to the group of benign systemic granulomatosis, occurring with damage to mesenchymal and lymphatic tissues various organs, but mainly the respiratory system. Patients with sarcoidosis are concerned about increased weakness and fatigue, fever, chest pain, cough, arthralgia, and skin lesions. In the diagnosis of sarcoidosis, radiography and CT of the chest, bronchoscopy, biopsy, mediastinoscopy or diagnostic thoracoscopy are informative. For sarcoidosis, long-term treatment courses with glucocorticoids or immunosuppressants are indicated.

Pulmonary sarcoidosis

Pulmonary sarcoidosis - poly systemic disease, characterized by the formation of epithelioid granulomas in the lungs and other affected organs. Sarcoidosis is a disease predominantly of young and middle-aged people (20-40 years), often female. The ethnic prevalence of sarcoidosis is higher among African Americans, Asians, Germans, Irish, Scandinavians, and Puerto Ricans.

In 90% of cases, sarcoidosis of the respiratory system is detected with damage to the lungs, bronchopulmonary, tracheobronchial, and intrathoracic lymph nodes. Sarcoid lesions of the skin (48% - subcutaneous nodules, erythema nodosum), eyes (27% - keratoconjunctivitis, iridocyclitis), liver (12%) and spleen (10%) are also quite common. nervous system(4-9%), parotid salivary glands (4-6%), joints and bones (3% - arthritis, multiple cysts of the digital phalanges of the feet and hands), heart (3%), kidneys (1% - nephrolithiasis, nephrocalcinosis) and other organs.

The morphological substrate of sarcoidosis is the formation of multiple granulomas from epitolyoid and giant cells. Although externally similar to tuberculous granulomas, sarcoid nodules are not characterized by the development of caseous necrosis and the presence of Mycobacterium tuberculosis in them. As they grow, sarcoid granulomas merge into multiple large and small foci. Foci of granulomatous accumulations in any organ disrupt its function and lead to the appearance of symptoms of sarcoidosis. The outcome of sarcoidosis is the resorption of granulomas or fibrotic changes affected organ.

Causes and mechanism of development of sarcoidosis of the lungs

Beck's sarcoidosis is a disease of unknown etiology. None of the put forward theories provides reliable knowledge about the nature of the origin of sarcoidosis. Followers of the infectious theory suggest that the causative agents of sarcoidosis can be mycobacteria, fungi, spirochetes, histoplasma, protozoa and other microorganisms. There is research data based on observations of familial cases of the disease and testifying in favor of the genetic nature of sarcoidosis. Some modern researchers associate the development of sarcoidosis with a violation of the body's immune response to the influence of exogenous (bacteria, viruses, dust, chemicals) or endogenous factors (autoimmune reactions).

There is a certain trend in the incidence of sarcoidosis in representatives of certain professions: agricultural workers, chemical workers, healthcare workers, sailors, postal workers, millers, mechanics, firefighters due to increased toxic or infectious exposure, as well as smokers.

As a rule, sarcoidosis is characterized by a multiorgan course. Pulmonary sarcoidosis begins with a lesion alveolar tissue and is accompanied by the development of interstitial pneumonitis or alveolitis with the subsequent formation of sarcoid granulomas in the subpleural and peribronchial tissues, as well as in the interlobar grooves. Subsequently, the granuloma either resolves or undergoes fibrotic changes, turning into an acellular hyaline (vitreous) mass.

As pulmonary sarcoidosis progresses, severe disturbances in ventilation function develop, usually of a restrictive type. When the lymph nodes compress the walls of the bronchi, obstructive disorders are possible, and sometimes the development of zones of hypoventilation and atelectasis.

Classification of pulmonary sarcoidosis

Based on the obtained radiological data, three stages and corresponding forms are distinguished during pulmonary sarcoidosis.

Stage I (corresponds to the initial intrathoracic lymphoglandular form of sarcoidosis) – bilateral, often asymmetrical enlargement of bronchopulmonary, less often tracheobronchial, bifurcation and paratracheal lymph nodes.

Stage II (corresponds to the mediastinal-pulmonary form of sarcoidosis) - bilateral dissemination (miliary, focal), infiltration of the lung tissue and damage to the intrathoracic lymph nodes.

Stage III (corresponds to the pulmonary form of sarcoidosis) – severe pneumosclerosis (fibrosis) of the lung tissue, no enlargement of intrathoracic lymph nodes. As the process progresses, confluent conglomerates form against the background of increasing pneumosclerosis and emphysema.

According to the clinical and radiological forms and localization encountered, sarcoidosis is distinguished:

Intrathoracic lymph nodes (HTNL)
Lungs and VGLU
Lymph nodes
Lungs
Respiratory system, combined with damage to other organs
Generalized with multiple organ lesions

During pulmonary sarcoidosis, there is an active phase (or exacerbation phase), a stabilization phase and a phase of reverse development (regression, attenuation of the process). Reverse development can be characterized by resorption, thickening and, less commonly, calcification of sarcoid granulomas in the lung tissue and lymph nodes.

According to the rate of increase in changes, the development of sarcoidosis can be abortive, slow, progressive or chronic. Consequences of the outcome of pulmonary sarcoidosis after stabilization of the process or cure may include: pneumosclerosis, diffuse or bullous emphysema, adhesive pleurisy, hilar fibrosis with calcification or absence of calcification of the intrathoracic lymph nodes.

Symptoms of pulmonary sarcoidosis

The development of pulmonary sarcoidosis may be accompanied by nonspecific symptoms: malaise, anxiety, weakness, fatigue, loss of appetite and weight, fever, night sweats, sleep disturbances. In the intrathoracic lymphoglandular form, half of the patients have an asymptomatic course of pulmonary sarcoidosis, while the other half have clinical manifestations in the form of weakness, pain in the chest and joints, cough, fever, and erythema nodosum. Percussion reveals bilateral enlargement of the roots of the lungs.

The pulmonary form of sarcoidosis is characterized by shortness of breath, cough with sputum, chest pain, and arthralgia. The course of stage III sarcoidosis is aggravated by clinical manifestations of cardiopulmonary failure, pneumosclerosis and emphysema.

Complications of pulmonary sarcoidosis

The most common complications of pulmonary sarcoidosis are emphysema, broncho-obstruction syndrome, respiratory failure, cor pulmonale. Against the background of pulmonary sarcoidosis, the addition of tuberculosis, aspergillosis and nonspecific infections is sometimes noted.

Fibrosis of sarcoid granulomas in 5-10% of patients leads to diffuse interstitial pneumosclerosis, up to the formation of “honeycomb lung”. Serious consequences threaten the appearance of sarcoid granulomas of the parathyroid glands, causing disturbances in calcium metabolism and the typical clinical picture of hyperparathyroidism, including death. If diagnosed late, sarcoid eye disease can lead to complete blindness.

Diagnosis of pulmonary sarcoidosis

The acute course of sarcoidosis is accompanied by changes in laboratory blood parameters, indicating an inflammatory process: a moderate or significant increase in ESR, leukocytosis, eosinophilia, lymphocytosis and monocytosis. The initial increase in titers of α- and β-globulins as sarcoidosis develops is replaced by an increase in the content of γ-globulins.

Characteristic changes in sarcoidosis are revealed by X-ray of the lungs, during CT or MRI of the lungs - a tumor-like enlargement of the lymph nodes is determined, mainly at the root, a symptom of “backstage” (superimposition of the shadows of the lymph nodes on each other); focal dissemination; fibrosis, emphysema, cirrhosis of lung tissue. More than half of patients with sarcoidosis have positive reaction Kveima is the appearance of a purplish-red nodule after intradermal injection of 0.1-0.2 ml of specific sarcoid antigen (substrate of the patient’s sarcoid tissue).

The most informative method for diagnosing sarcoidosis is histological examination biopsy obtained during bronchoscopy, mediastinoscopy, prescale biopsy, transthoracic puncture, open lung biopsy. Morphologically, the biopsy specimen reveals elements of an epithelioid granuloma without necrosis and signs of perifocal inflammation.

Treatment of pulmonary sarcoidosis

Considering the fact that a significant part of cases of newly diagnosed sarcoidosis is accompanied by spontaneous remission, patients are monitored for 6-8 months to determine the prognosis and the need for specific treatment. Indications for therapeutic intervention include severe, active, progressive sarcoidosis, combined and generalized forms, damage to the intrathoracic lymph nodes, and severe dissemination in the lung tissue.

Prednisolone therapy is started with a loading dose, then the dosage is gradually reduced. If prednisolone is poorly tolerated, the presence of undesirable side effects, exacerbation of concomitant pathology, therapy for sarcoidosis is carried out according to an intermittent regimen of glucocorticoids every 1-2 days. During hormonal treatment, a protein diet with limited salt, potassium supplements and anabolic steroids are recommended.

When prescribing a combination treatment regimen for sarcoidosis, a 4-6 month course of prednisolone, triamcinolone or dexamethasone is alternated with non-steroidal anti-inflammatory therapy with indomethacin or diclofenac. Treatment and follow-up of patients with sarcoidosis is carried out by phthisiatricians. Patients with sarcoidosis are divided into 2 dispensary groups:

I – patients with active sarcoidosis:
IA – diagnosis established for the first time;
IB – patients with relapses and exacerbations after a course of primary treatment.
II – patients with inactive sarcoidosis (residual changes after clinical and radiological cure or stabilization of the sarcoid process).

Dispensary registration for favorable development of sarcoidosis is 2 years, in more severe cases – from 3 to 5 years. After treatment, patients are removed from the dispensary register.

Prognosis and prevention of sarcoidosis

Specific measures to prevent sarcoidosis have not been developed due to unclear causes of the disease. Nonspecific prevention consists of reducing the exposure of the body to occupational hazards in people at risk and increasing the body's immune reactivity.

Pulmonary sarcoidosis - treatment in Moscow

Directory of diseases

Respiratory diseases

Last news

for informational purposes only

and does not replace qualified medical care.

What you need to know about pulmonary sarcoidosis?

Pulmonary sarcoidosis belongs to the category of diseases classified as systemic granulomatosis of a benign nature of formation. The disease affects young people aged 25 to 40 years, women are most susceptible.

Causes

Sarcoidosis of the lungs is similar in its manifestations to tuberculosis, but only in external signs. Sarcoid granules form in the lungs, which merge into small and large lesions. When there are many of them, the internal organs in which the disease is localized, as well as those located nearby, suffer. Symptoms of sarcoidosis occur when the number of granules becomes large and interferes with the functioning of the lungs. The disease can develop in two ways:

The granules dissolve on their own and the disease recedes.
Fibrous changes in the lungs affect the respiratory system and lead to critical consequences.

Doctors are still arguing about the causes of sarcoidosis; new studies are emerging that allow new assumptions to be made. There are several theories about the origin of the disease: infectious, immune, genetic. Proponents of the infectious theory argue that the causative agents of sarcoidosis are microorganisms, fungi, spirochetes and other protozoa that get inside.

Research shows that pulmonary sarcoidosis is a disease that runs in families, meaning genetic predisposition plays an important role. Another group of specialists classifies sarcoidosis as an immune disorder. The version is based on the presence of autoimmune and exogenous reactions. The development of the disease is influenced by causes that provoke a disorder in the immune system. These could be dust particles, bacteria, chemicals, viruses.

There is reason to believe that people in certain professions are most susceptible to sarcoidosis. The risk group includes specialists in chemical production, firefighters, agricultural workers, sailors, and postal employees. This is due to prolonged exposure to chemicals and toxic substances. Special attention should be given to people with nicotine addiction: the risk of developing the disease increases significantly in this case.

How does the disease progress?

Beck-Besnier-Chaiman sarcoidosis is a disease with a multiorgan course. Initially, the disease affects the alveolar tissue, then alveolitis or interstitial pneumonitis develops. After this, a sarcoid granuloma appears in the organs, which is localized in the peribronchial and subpleural tissues.

The stages of pulmonary sarcoidosis are determined by the amount of granulomatous tissue and its effect on the body. Granulomas can resolve and disappear, or cause fibrotic changes and provoke a negative process. The tissues take on a glassy shape. As the disease progresses, disturbances occur that do not allow the ventilation function of the lungs to function normally. When the walls of the bronchi are compressed by intrathoracic lymph nodes (intrathoracic lymph nodes), an obstructive disorder occurs, sometimes leading to atelectasis and the appearance of a zone of hyperventilation.

As a disease, sarcoidosis is classified into three stages, which are diagnosed after x-rays. The first stage is characterized by initial symptoms that are associated with a bilateral and asymmetric increase in the size of the bronchopulmonary lymph nodes, tracheobronchial, paratracheal lymph nodes. Sarcoidosis of the 2nd degree or second stage is called the mediastinal-pulmonary form. In this case, infiltration of the lung tissue and damage to the intrathoracic lymph nodes occurs.

At the third stage, called pulmonary, the disease provokes fibrosis, which actively develops in the lung tissue. At the same time, there is no enlargement of the intrathoracic lymph nodes, which is present at the previous stage. The patient exhibits an increase in emphysema and pneumosclerotic phenomena. Pulmonary sarcoidosis develops from an exacerbation phase to a stabilization phase and then moves to a regression phase. The disease acquires the character of either a chronic and slow course or a progressive one.

Symptoms

Signs of sarcoidosis are nonspecific manifestations. This may include weakness, increased fatigue, decreased appetite, sleep disturbances and fever, and increased sweating. In the intrathoracic form of sarcoidosis, classic symptoms do not appear; sarcoidosis is asymptomatic. In other forms, if the patient is suspected of having sarcoidosis of the skin or lungs, the signs and symptoms will look like this:

general weakness;
chest pain;
pain and aches in the joints;
cough with fever;
formation of erythema nodosum.

With sarcoidosis, complications occur that manifest themselves in the form of emphysema, respiratory dysfunction, and broncho-obstruction syndrome. A complication called “cor pulmonale” deserves special attention. It is characterized by expansion and enlargement of the right side of the heart, which is caused by an increase blood pressure in the pulmonary circulation due to sarcoidosis.

In pulmonary sarcoidosis, patients have tuberculosis or other infectious diseases. Due to fibrotic disorder, more than 10% of patients deal with diffuse interstitial pneumosclerotic phenomena. The lung tissue may be riddled with holes.

Diagnostics

The acute course of pulmonary sarcoidosis is seen with laboratory research, since the disease immediately manifests itself in blood tests. This allows you to determine the presence of inflammation. To separate it from other pulmonary diseases of an infectious nature, a number of studies are carried out. The main way to know that a patient has pulmonary sarcoidosis is to do an X-ray, CT scan of the lung, and MRI. On MRI, you can see the deformation of the lymph nodes, which will immediately lead to the correct diagnosis.

Half of the patients have a positive Kveim reaction. It is carried out on the skin of the subject using an antigen. If sarcoidosis is suspected, a biopsy and bronchoscopy are prescribed to identify direct or indirect signs of the disease. The internal organs are examined for the presence of vessel dilatation in the area of the mouth of the lobar bronchi.

The most accurate method for detecting sarcoidosis is a histological examination, which is done on a biopsy specimen, which is removed during bronchoscopic examination. It takes time to make an accurate diagnosis. The full range of analytics can be covered in a few months. Until an accurate result is obtained, treatment is not started. At some level it is possible to fight the symptoms, but until the cause is established, all the local elimination of signs will only interfere with the overall picture of the disease.

Treatment

Sarcoidosis is a disease with many nuances, so treatment varies.

Concrete conclusions should be made no earlier than after six months of observation and research.

Medical assistance is provided to people with a severe and active course of the pulmonary form of sarcoidosis, with a generalized and combined form, when a lesion of the intrathoracic lymph node is detected, dissemination of lung tissue of a pronounced property.

If a patient is diagnosed with sarcoidosis, treatment will depend on a number of factors. This is due to the severity of symptoms, duration of the disease, dynamics of the course, and response to treatment. Under certain conditions, cutaneous sarcoidosis manifests itself, which is always part of the overall picture.

The main component of drug therapy for pulmonary sarcoidosis is corticosteroid drugs, anti-inflammatory and immunostimulating agents. An important role is played by following a diet and a healthy lifestyle, avoiding alcohol, cigarettes and junk food. There are contraindications for active therapy, and compliance with all doctor’s requirements is important.

After treatment for pulmonary sarcoidosis, the patient should be observed by a specialist for at least two years to monitor remission and exacerbation. If the disease had complications, then observation by a doctor can last up to five years. A specialist who deals with such diseases is a pulmonologist. If you suspect symptoms or have a genetic predisposition to sarcoidosis, you should consult with him. With a disease such as sarcoidosis, the causes may be different, but the course of the disease is similar.

The sooner you can find out about the likelihood of developing sarcoidosis, the easier it is to control your health condition. Prevention consists of following healthy image life and regular visits to the doctor. It is necessary to avoid, if possible, contact with chemicals and hazardous industries. In an urban environment, a person is exposed to the negative influence of the surrounding world, so one should spend more time in the fresh air, choose quiet areas for living with a minimum number of cars, away from factories and industries. It is important to find out about the presence of a genetic predisposition. This can be done by asking relatives in detail.

Particular attention should be paid to lung health for smokers, active and passive. Regular inhalation of toxic substances contained in cigarettes and hookahs leads to diseases of the respiratory system and disturbances in the functioning of the cardiovascular system.

Signs, symptoms, prognosis and treatment of pulmonary sarcoidosis

Sarcoidosis (also known as Besnier-Beck-Schaumann disease) is quite rare inflammatory disease, affecting mainly only the lungs. In some cases, it spreads to other internal organs - spleen, liver, The lymph nodes, less often - bones, eyes, skin. Young and older women suffer from the disease more often.

Pulmonary sarcoidosis is characterized as a systemic disease of unknown etiology, in which granulomas with possible partial necrosis are formed in the organs, but without the caseous changes characteristic of tuberculosis. It is not a tumor disease and has narrowed foci of inflammation, which consist of an accumulation of healthy cells and modified ones.

It is not infectious, however, cases of disease in families have been recorded, which can be explained by adverse effects environment or heredity.

A little history

The first case of the disease was recorded in late XIX century (in 1877) in England (London), when a dermatologist-surgeon Jonathan Hudchinson discovered in his 53-year-old patient on his arms and legs painless purple rashes that had a disk-like shape.

A little later, in 1889, the French physician Ernest Besnier recorded an unknown disease before this case, which manifested itself in the form of swelling of the nose (with the formation of erosion of the mucous membrane), ears and fingers. In the same year, dermatologist Caesar Beck (Norway) after long research skin changes, gave the name to the disease - "multiple benign sarcoidosis of the skin." He also noted that not only the skin is affected, but also the lungs, liver, etc.

In the 1930s, Swedish chest doctor Sven Lofgren established that the combination of bilateral hilar lymphadenopathy with erythema nodosum is the initial form of acute sarcoidosis.

Classification

The first classification of lung sarcodiasis was proposed in 1958 by K. Wurm. It was based on radiological indications and was divided into three stages:

I stage. Lymphadenopathy of the mediastinum.
II stage. Localized darkening of lung tissue. Often there is a decrease in the size of the lymph nodes against the background of an increase in the pulmonary pattern. This stage, in turn, includes the following stages:

IIa – pulmonary pattern is deformed;
IIb – small-focal bilateral changes in the lungs spread;
IIc – mid-focal bilateral changes in the lungs are spreading;
IId – large-focal modifications spread in the lungs

III stage. Disseminated intratissue fibrosis of lung tissue.

After long observations of the disease, scientists from the Central Research Institute of Tuberculosis of the Russian Academy of Medical Sciences proposed to deviate from such a classification. They argued that, despite the phase nature, a typical transition from one stage to the next does not always occur and this is not a decisive factor for establishing the nature of disease progression. So, in 1983, Academician A. G. Khomenko proposed the following classification:

sarcoidosis of the respiratory organs;
sarcoidosis of other internal organs;
widespread (widespread) sarcoidosis.

In turn, the academician proposed to classify pulmonary sarcoidosis as follows:

I. According to clinical and radiological forms:

intrathoracic lymph nodes (HTLU);
intrathoracic lymph nodes and lungs;
lungs;
respiratory organs, combined with damage to other organs;
widespread with damage to the respiratory organs.

II. According to the characteristics of the course of the disease:

stages: dynamic and regression;
character: suspending (abortive), sluggish, progressive, chronic;
complications: atelectasis, bronchial stenosis, hypopneumatosis, etc.

III. For residual modifications:

emphysema;
fibrosis of the roots of the lungs (with or without possible calcification of the VLN);
adhesive pleurisy;
pneumosclerosis.

For many years, this classification was considered the most accurate and comprehensive.

Modern classification

Currently, the commonly used classification is the division of sarcoidosis of the respiratory organs into five stages (or types):

Stage 0 – no changes are observed on the chest x-ray (5%);
Stage I – lung parenchyma is not changed, thoracic lymphadenopathy (50%);
II stage - pathological changes pulmonary parenchyma, lymphadenopathy of the mediastinum and pulmonary roots (30%);
Stage III – no lymphadenopathy, pathology of the lung parenchyma (15%);
Stage IV – irreversible pulmonary fibrosis (20%).

US scientists in 2001 proposed a slightly different classification:

Acute sarcoidosis:

mild severity of the disease – erythema nodosum, anterior uveitis, maclopapular skin changes;
moderate severity - Bell's palsy, hypercalcemia, shortness of breath (with vital capacity more than 60%);
severe degree - hypersplenism, hypercalcemia combined with renal failure, impaired respiratory ability of the lungs (with vital capacity less than 60%)

Chronic sarcoidosis:

mild form - damage to all areas of the skin except the face;
moderate form - the bones of the hands undergo cystic changes;
severe form - neurological disorders (no Bell's palsy), cardiomyopathy

Refractory sarcoidosis (moderate to severe) – neurological manifestations unresponsive to corticosteroid treatment, respiratory failure, refractory myocardiopathy.

The study of pulmonary sarcoidosis for physicians has become one of the important tasks in recent decades. The disease has not been fully studied, therefore, it is possible that adjustments will still be made to the existing classification.

Causes

For about 150 years, humanity has known about this disease, but the exact cause of its occurrence has not yet been established. There are several hypotheses that are most likely the cause of sarcoidosis:

Mycobacteria. Sarcoidosis has pathohistological similarities to tuberculosis, which is caused by mycobacteria.
Chlamydia. Some association has been noted between sarcoidosis and the presence of chlamydia.
Lyme borreliosis. Sarcoidosis shares many features with Lyme disease, which is carried by animals.
Propionic bacteria.
Viruses. Scientists have found that all patients with sarcoidosis are seropositive for the rubella virus and have more high level antibody titer than healthy people of the same age.
Environmental factors. In particular, inhalation of metal dust.

Some scientists believe that possible reason The disease is hereditary, but this version, according to others, is unlikely.

Signs and symptoms

Usually, initial stages Sarcoidosis is asymptomatic, so it can only be detected by X-ray examination. With further development of the disease, the following symptoms appear:

fast fatiguability;
loss of appetite;
weight loss;
general malaise;
mild fever that is persistent

These symptoms are a sign of many diseases, so it is impossible to make an unambiguous diagnosis from them.

For sarcoidosis of the lungs of 2 degrees or more, the following signs are characteristic, which appear in the later stages:

shortness of breath;
increased sweating;
prolonged cough (dry or wet);
in advanced forms of the disease, expectoration of blood is possible;
arrhythmia;
skin lesions in the form of a rash (most often on the lower legs) and erythema nodosum;
enlargement of intrathoracic and peripheral lymph nodes;
inflammation of the choroid

The most telling symptom of any form of sarcoidosis is increased fatigue. Often, the patient cannot get out of bed in the morning, and during the day fatigue prevents him from leading a full life.

Second a clear sign sarcoidosis - localized pain in the chest, not associated with the breathing process, as well as the appearance of nodular skin rashes of a bright red color, often painful to the touch.

Acute sarcoidosis is characterized by the same symptoms, combined with pain and swelling of the joints (most often the knees and ankles), granulomas and fever. Acute pulmonary sarcoidosis is most often benign and resolves within 6 months. If the disease is not cured after six months, it becomes chronic, which is characterized by the following symptoms:

polyarthritis that affects the small joints of the hand and wrist;
possible development of pulmonary failure;
asymptomatic pulmonary adenopathy

Often, the only manifestation of the disease is lymphadenopathy, in which the lymph nodes are enlarged but painless. In addition, the disease manifests itself differently in representatives of one race or another. Thus, people of the Negroid race are more susceptible to damage to the eyes, bone marrow, liver and skin. Women suffer from erythema nodosum and nervous system disorders, and men suffer from hypercalcemia. In children, the disease manifests itself as arthritis, uveitis and skin rashes.

Diagnostics

Before treating sarcoidosis, it is necessary to undergo a thorough examination by appropriate specialists.

The very first action if pulmonary sarcoidosis is suspected is an X-ray examination. According to the results of radiography, the disease can be detected when lymphadenopathy of the roots of the lung is detected. These changes are the most common signs of the disease, and are also considered prognostic signs of remission.

If the result of radiography does not give a complete picture and doctors still have doubts, it is necessary to carry out computed tomography(high resolution) of the chest, which is more sensitive to detecting lymphadenopathy of the mediastinum and chest. In later stages (II-IV), such a study shows nodular changes in the interlobular septa, thickened bronchovascular connections and bronchial walls, cysts, parenchymal nodules and bronchial distension.

If imaging studies show positive result, then the next stage of diagnosis is a biopsy to determine non-caseating granulomas, as well as to exclude other causes of their appearance. In order for a biopsy to give a full result, it is important to choose the right site, determine the severity of the disease and the need for therapy. This method (biopsy), in most cases, gives the most complete picture of the disease. Areas are usually determined by palpation and physical examination.

To clarify the spread of the disease, additional laboratory tests are prescribed - liver function tests (they provide complete information for detecting extrathoracic lesions), a blood test for electrolytes and urea nitrogen.

In addition, as additional research, use gallium scanning of the whole body, which can provide complete information in the absence of tissue damage. Also, a bronchoalveolar lavage test provides additional information regarding protein and lipid content.

To identify other organs that are affected by sarcoidosis, the following diagnostic procedures are performed:

Ultrasound of the abdominal cavity;
MRI (magnetic resonance imaging) of the heart;
ECG (electrocardiography) or ECHO-KG (echocardiography) to determine the functional state of the heart

Based on all studies, the stage and form of the disease, the affected areas are determined and appropriate treatment is prescribed.

Treatment

There is currently no consensus regarding the treatment of sarcoidosis. Most experts adhere to the fact that sarcoidosis of the lungs should be treated when, in addition to the lungs, other vital organs (heart, liver, eyes, spleen, etc.) are affected, or the disease has a progressive form. If the disease is asymptomatic and does not spread throughout the body, treatment is not prescribed, but the patient is carefully monitored.

An important point in treatment is adjusting the patient’s diet. It is recommended to eat small meals 4-5 times a day. Food must be steamed. It is necessary to include a sufficient amount of calcium, vitamins E and C in the diet.

vegetables, fruits and natural juices;
sea fish, lean meat, eggs, liver;
fermented milk products (except for sour cream and cottage cheese);
walnuts, honey.

confectionery products (chocolate, cakes, pastries, etc.);
spicy, salty and fried foods;
highly carbonated drinks.

If you have pulmonary sarcoidosis, you must stop smoking and taking alcoholic beverages, as this may worsen the progression of the disease and reduce the effect of medications.

Glucocorticoids are used to treat pulmonary sarcoidosis general action. In the vast majority of cases, prednisolone is prescribed in a dosage of 0.3 to 1 mg/kg orally once a day. In rare cases (if other organs are affected), daily dose increase. The body's response to treatment is observed within 2-4 weeks. After a response to treatment is detected, the amount of prednisolone is reduced to a maintenance dose.

The optimal duration of treatment is not yet known, however, it is important not to reduce the dosage prematurely, as there is a high likelihood of relapse. On average, treatment with prednisone lasts from 6 to 12 months, depending on the form and severity of the disease.

About 10% of patients requiring therapy are resistant to the action of glucocorticoids. In such cases, a trial course of methotrexate is prescribed. The duration of the course is 6 months and it is prescribed simultaneously with the course of prednisolone (its dosage is reduced at the 8th week of treatment and in most cases it is canceled altogether). Patients taking methotrexate should have blood tests and liver enzyme tests. First every 2 weeks, then once a month.

With timely proper treatment, complete recovery of patients is observed. If lung sarcoidosis has progressed to advanced stages, relapse and/or complications are possible.

Complications, consequences and prevention

If sarcoidosis occurs at a young age and is acute with Löfgren's syndrome ( elevated temperature, erythema nodosum, joint pain), there is a high probability of spontaneous remission.

In advanced forms of sarcoidosis (stages III-IV), damage to the organs of vision, heart, nervous system and skin (except for erythema nodosum) is observed.

In some cases, with improper treatment or complete neglect of the disease, sarcoidosis becomes chronic.

However, the most serious complication is respiratory failure, which leads to intense work of the heart and reduces the functionality of the body.

Since the etiology of the disease is still unknown, guidelines for the prevention of sarcoidosis have not been developed. You should avoid contact with people who have sarcoidosis, and also avoid getting metal dust (barium, aluminum, cobalt, titanium, gold, copper, beryllium and zirconium) into your lungs.

Pulmonary sarcoidosis is a systemic and benign accumulation of inflammatory cells (lymphocytes and phagocytes), with the formation of granulomas (nodules), with an unknown cause.

Mostly the age group 20–45 years old is affected, the majority are women. The frequency and magnitude of this disorder is within the range of 40 diagnosed cases per 100,000 (according to EU data). East Asia has the lowest prevalence, with the exception of India, where the rate of patients with this disorder is 65 per 100,000. It is less common in childhood and in the elderly.

Pathogenic granulomas are most common in the lungs of certain ethnic groups, such as African Americans, Irish, Germans, Asians, and Puerto Ricans. In Russia, the prevalence rate is 3 per 100,000 people.

What it is?

Sarcoidosis is an inflammatory disease that can affect many organs and systems (in particular the lungs), characterized by the formation of granulomas in the affected tissues (this is one of diagnostic signs diseases that are detected by microscopic examination; limited foci of inflammation, having the form of a dense nodule of various sizes). Lymph nodes, lungs, liver, spleen are most often affected, less often - skin, bones, organ of vision, etc.

Reasons for development

Oddly enough, the true causes of pulmonary sarcoidosis are still unknown. Some scientists believe the disease is genetic, others that pulmonary sarcoidosis occurs due to impaired functioning of the human immune system. There are also suggestions that the cause of the development of pulmonary sarcoidosis is a biochemical disorder in the body. But at the moment, most scientists are of the opinion that the combination of the above factors is the cause of the development of pulmonary sarcoidosis, although not a single theory put forward confirms the nature of the origin of the disease.

Scientists studying infectious diseases suggest that protozoa, Histoplasma, spirochetes, fungi, mycobacteria and other microorganisms are the causative agents of pulmonary sarcoidosis. Endogenous and exogenous factors can also cause the development of the disease. Thus, today it is generally accepted that pulmonary sarcoidosis of polyetiological origin is associated with a biochemical, morphological, immune disorder and genetic aspect.

The incidence is observed in persons of certain professions: firefighters (due to increased toxic or infectious exposure), mechanics, sailors, millers, agricultural workers, postal workers, chemical industry and healthcare workers. Pulmonary sarcoidosis is also observed in people with tobacco addiction. Availability allergic reaction for some substances that are perceived by the body as foreign due to a violation of immunoreactivity, does not exclude the development of sarcoidosis of the lungs.

A cascade of cytokines is responsible for the formation of sarcoid granuloma. They can form in various organs, and also consist of a large number of T-lymphocytes.

Several decades ago, there was speculation that pulmonary sarcoidosis was a form of tuberculosis caused by weakened mycobacteria. However, according to the latest data, it has been established that these are different diseases.

Classification

Based on the obtained radiological data, three stages and corresponding forms are distinguished during pulmonary sarcoidosis.

Stage I (corresponds to the initial intrathoracic lymphoglandular form of sarcoidosis) – bilateral, often asymmetrical enlargement of bronchopulmonary, less often tracheobronchial, bifurcation and paratracheal lymph nodes.
Stage II (corresponds to the mediastinal-pulmonary form of sarcoidosis) - bilateral dissemination (miliary, focal), infiltration of the lung tissue and damage to the intrathoracic lymph nodes.
Stage III (corresponds to the pulmonary form of sarcoidosis) – severe pneumosclerosis (fibrosis) of the lung tissue, no enlargement of intrathoracic lymph nodes. As the process progresses, confluent conglomerates form against the background of increasing pneumosclerosis and emphysema.

According to the clinical and radiological forms and localization encountered, sarcoidosis is distinguished:

Intrathoracic lymph nodes (HTNL)
Lungs and VGLU
Lymph nodes
Lungs
Respiratory system, combined with damage to other organs
Generalized with multiple organ lesions

Symptoms and first signs

The development of pulmonary sarcoidosis is characterized by the appearance of non-specific symptoms. These include in particular:

Malaise;
Anxiety;
Fatigue;
General weakness;
Weight loss;
Loss of appetite;
Fever;
Sleep disorders;
Night sweats.

The intrathoracic (lymph glandular) form of the disease is characterized for half of the patients by the absence of any symptoms. Meanwhile, the other half tend to identify symptoms of the following type:

Weakness;
Painful sensations in the chest area;
Joint pain;
Dyspnea;
Wheezing;
Cough;
Temperature increase;
The appearance of erythema nodosum (inflammation of subcutaneous fat and blood vessels of the skin);
Percussion (examination of the lungs in the form of percussion) determines the increase in the roots of the lungs in a bilateral manner.

As for the course of such a form of sarcoidosis as the mediatral-pulmonary form, the following symptoms are characteristic of it:

Cough;
Dyspnea;
Pain in the chest area;
Auscultation (listening to characteristic sound phenomena in the affected area) determines the presence of crepitus (a characteristic "crunchy" sound), scattered dry and moist rales.
The presence of extrapulmonary manifestations of the disease in the form of damage to the eyes, skin, lymph nodes, bones (in the form of the Morozov-Junling symptom), damage to the salivary parotid glands (in the form of the Herford symptom).

Complications

The most common consequences of this disease include the development of respiratory failure, cor pulmonale, emphysema (increased airiness of the lung tissue), and broncho-obstructive syndrome.

Due to the formation of granulomas in sarcoidosis, pathology is observed in the organs on which they appear (if the granuloma affects the parathyroid glands, calcium metabolism is disrupted in the body, hyperparathyroidism is formed, from which patients die). Against the background of weakened immunity, other infectious diseases (tuberculosis) may occur.

Diagnostics

Without an accurate analysis, it is impossible to clearly classify the disease as sarcoidosis.

Many signs make this disease similar to tuberculosis, so careful diagnosis is necessary to establish a diagnosis.

Survey - decreased ability to work, lethargy, weakness, dry cough, chest discomfort, joint pain, blurred vision, shortness of breath;
Auscultation - hard breathing, dry wheezing. Arrhythmia;
Blood test - increased ESR, leukopenia, lymphopenia, hypercalcemia;
X-ray and CT scan - the “ground glass” symptom, pulmonary dissemination syndrome, fibrosis, compaction of lung tissue are determined;

Other devices are also used. An effective bronchoscope is one that looks like a thin, flexible tube that is inserted into the lungs to examine and take tissue samples. Under certain circumstances, a biopsy may be used to analyze tissue for cellular level. The procedure is carried out under the influence of an anesthetic, so it is practically invisible to the patient. A thin needle plucks off a piece of inflamed tissue for subsequent diagnosis.

How to treat pulmonary sarcoidosis

The treatment of pulmonary sarcoidosis is based on the use of hormonal drugs corticosteroids. Their action in this disease is as follows:

weakening of the perverted reaction from the immune system;
preventing the development of new granulomas;
anti-shock effect.

There is still no consensus regarding the use of corticosteroids for pulmonary sarcoidosis:

when to start treatment;
how long to carry out therapy;
what should be the initial and maintenance doses.

A more or less established medical opinion regarding the prescription of corticosteroids for pulmonary sarcoidosis is that hormonal drugs can be prescribed if radiological signs of sarcoidosis do not disappear within 3-6 months (regardless of clinical manifestations). Such waiting periods are maintained because in some cases the disease may regress (reverse development) without any medical prescriptions. Therefore, based on the condition of a particular patient, we can limit ourselves to medical examination (registering the patient) and monitoring the condition of the lungs.

In most cases, treatment begins with prednisolone. Next, inhaled corticosteroids and for intravenous administration. Treatment is long-term - for example, inhaled corticosteroids can be prescribed for up to 15 months. There have been cases when inhaled corticosteroids were effective in stages 1-3 even without intravenous corticosteroids - both the clinical manifestations of the disease and pathological changes on X-ray images disappeared.

Since sarcoidosis affects other organs in addition to the lungs, this fact must also be taken into account when making medical prescriptions.

In addition to hormonal drugs, other treatments are prescribed:

broad-spectrum antibiotics - for prevention and in case of an immediate threat of developing secondary pneumonia due to infection;
if the viral nature of secondary lung damage in sarcoidosis is confirmed, antiviral drugs are used;
with the development of congestion in the circulatory system of the lungs - drugs that reduce pulmonary hypertension(diuretics and so on);
restoratives - first of all, vitamin complexes that improve the metabolism of lung tissue and help normalize immunological reactions characteristic of sarcoidosis;
oxygen therapy for the development of respiratory failure.

It is recommended not to eat foods rich in calcium (milk, cottage cheese) and not to sunbathe. These recommendations are due to the fact that with sarcoidosis the amount of calcium in the blood may increase. At a certain level, there is a risk of formation of calculi (stones) in the kidneys, bladder and gall bladder.

Since pulmonary sarcoidosis is often combined with the same damage to other internal organs, consultation and appointments of related specialists are necessary.

Prevention of disease complications

Prevention of complications of the disease involves limiting contact with factors that could cause sarcoidosis. First of all, we are talking about environmental factors that can enter the body with inhaled air. Patients are advised to regularly ventilate the apartment and do wet cleaning to avoid air dust and mold formation. In addition, it is recommended to avoid prolonged sunbathing and stress, as they lead to disruption of metabolic processes in the body and intensification of the growth of granulomas.

TO preventive measures Avoiding hypothermia also applies, as this can contribute to the addition of a bacterial infection. This is due to deterioration of lung ventilation and weakened immunity in general. If there is already a chronic infection in the body, then after sarcoidosis is confirmed, it is necessary to visit a doctor to find out how to control the infection most effectively.

Pulmonary sarcoidosis: what is it? Pulmonary sarcoidosis, or Beck's sarcoidosis, is one of the diseases related to systemic benign granulomatosis that affects the lymphatic and mesenchymal tissue of various internal human organs, mainly the respiratory organs.

The development of such a pathological process is characterized by the appearance of epithelial granulomas in organs affected by the inflammatory process, including the lungs. Granulomas are a kind of inflammation of the tissues of an internal organ and have the appearance of nodular neoplasms. Such neoplasms after a certain period of time can merge with each other and have a multiple character. The formation of foci of sarcoidosis granulomas in a particular organ causes various disturbances in its functioning, as a result of which a person develops characteristic manifestations of the development of sarcoidosis.

This disease mainly affects people of young and middle age, that is, from 20 to 40 years. At the same time, pulmonary sarcoidosis is most often diagnosed in the fair sex. The final stage of development of Beck's sarcoidosis is characterized by either complete resorption of nodular neoplasms in the lungs or the formation of fibrous changes in the tissues of this internal organ.

Causes of the disease and its mechanism of development

The nature of the occurrence of such a pathological process as Beck's sarcoidosis has not been fully established to date. However, there are many assumptions about the etiology of this disease. For example, there is an infectious theory of the origin of pulmonary sarcoidosis, which states that this kind of disease can occur in a person due to the development in his body of any pathogenic microorganisms (fungi, mycobacteria, histoplasma and spirochetes).

In addition, there is an assumption that this disease may have a genetic etiology, that is, be hereditary. This assumption was made as a result of observation in medical practice that members of the entire family were affected by pulmonary sarcoidosis.

Some experts argue that Beck's sarcoidosis occurs in a person against the background of the presence in his body of any disorders of an autoimmune nature, which can be formed as a result of exposure to both endogenous (autoimmune pathologies resulting from the pathological production of autoimmune antibodies, or killer cells that negatively affect healthy tissues of one’s own body) and exogenous (various chemicals, viruses, bacteria and dust) factors.

The development of pulmonary sarcoidosis in most cases is diagnosed in people working at any chemical enterprises, agricultural workers, sailors, mechanics, millers, employees in any health care institutions and firefighters. In addition, people who abuse tobacco smoking are at risk for the occurrence of such a pathological process. Such people are most at risk of developing pulmonary sarcoidosis, since their bodies are constantly exposed to various toxic substances and pathogenic microorganisms.

A disease such as Beck's sarcodiasis has a multiorgan course, the development of which occurs with the occurrence of an inflammatory process in the alveolar tissue of the lungs, which, in turn, is accompanied by the formation of extensive damage to the interstitial lung tissue (alveolitis) and the appearance of sarcoid tumors in the interlobar grooves, peribronchial and subpleural tissues. In case of further development of the pathological process, a person may experience serious disturbances in the respiratory function of the lungs.

Stages of development of pathology and its forms

This disease can occur in several stages, the development of which will correspond to the following forms of the pathological process:

intrathoracic (lymphoglandular) form. This form of development of pulmonary sarcoidosis is considered initial and therefore is the primary stage of development of the inflammatory process during internal organ. The first stage of the disease is characterized by bilateral enlargement of the bronchopulmonary, bifurcation, paratracheal and tracheobronchial lymph nodes;
Sarcoidosis of the 2nd stage of development is characterized by the occurrence of bilateral focal infiltration (the formation of an accumulation of cellular elements not characteristic of the composition of the lung tissue), as well as damage to the intrathoracic lymph nodes. Stage 2 pulmonary sarcoidosis corresponds to the development of such a form of pathological process as mediastinal-pulmonary sorcaidosis;
pulmonary form of Beck's sarcoidosis. The development of this form of pulmonary disease is characterized by the occurrence of pneumosclerosis (replacement of normal lung tissue with connective tissue). In this case, an increase in the size of the intrathoracic lymph nodes is not observed. The pulmonary form of sarcoidosis is the third stage of development of the pathological process. As a result of the progression of pneumosclerosis, the patient may develop a disease such as emphysema - chronic illness lungs, characterized by irreversible and persistent expansion of the air cavities and excessive swelling of the lung tissue.

Pulmonary sarcoidosis can develop in three main phases:

active, that is, exacerbation of the pathological process;
stabilization;
regression of pathology. that is, its gradual attenuation.

Moreover, this disease can occur in both acute and chronic forms.

Signs accompanying the development of the disease

Pulmonary sarcoidosis symptoms can be very diverse and at the same time have a nonspecific nature. Common manifestations of inflammation of the lung tissue include:

feeling of weakness and general malaise;
rapid fatigue even when performing minor physical activity;
feeling of inexplicable anxiety;
loss of appetite and, as a result, a sharp decrease in body weight;
fever (temporary increase in human body temperature);
various types of sleep disorders, characterized by a person’s inability to sleep normally at night;
increased sweating, occurring mainly at night.

The lymphoglandular form of the inflammatory process in the lung tissues may not be accompanied by any characteristic symptoms in half of the patients, while in the other half of people with sarcoidosis the following signs of the development of the pathological process may appear:

the appearance of painful and uncomfortable sensations in the chest area;
feeling of constant weakness;
painful sensations in the joints, which are especially noticeable when moving;
the occurrence of shortness of breath which may be accompanied by a dry cough;
hoarseness in the lungs when inhaling air;
increase in body temperature;
in the case of a procedure such as percussion (examination of the lungs using a special technique of tapping the chest), an increase in the size of the pulmonary roots is detected on both the right and left sides;
the formation of inflammatory processes in the superficial vessels of the skin and subcutaneous fat. This phenomenon is called erythema nodosum.

The mediastinal-pulmonary course of sarcoidosis, or sarcoidosis of the second stage, is accompanied by the appearance of the following symptoms in the patient:

severe cough;
shortness of breath;
pain in the thoracic region;
hoarseness in the lungs, the presence of which can be detected through auscultation (the doctor listens to the sounds that arise in the chest while a person inhales air).

The third stage, that is, the pulmonary form of development of the pathology, is characterized by the occurrence in a sick person of painful sensations in the sternum, shortness of breath, severe cough with sputum production. In addition, this stage of the inflammatory process in the lung tissues is accompanied by the occurrence of arthralgic manifestations (joint pain), cardiopulmonary failure, emphysema and pneumosclerosis.

Method of treating pulmonary pathology

Pulmonary sarcoidosis, the treatment of which lasts 6 to 8 months, is prescribed to a sick person only after dynamic monitoring of the patient’s general condition and the development of this disease. Providing emergency medical care is carried out only in the case of acute and severe pulmonary disease and if the patient has damage to the intrathoracic lymph nodes.

Inflammatory lung disease - sarcoidosis - is treated by prescribing the patient to take various anti-inflammatory and steroid drugs. medications. In addition, immunosuppressants and antioxidants are used in the treatment of this disease. The dosage and selection of medications is carried out only by the attending physician individually for each patient.

During the hormonal course of treatment for pulmonary sarcoidosis, the patient must use medications containing potassium and adhere to a special dietary nutrition based on high protein intake and limited salt intake.

Medical registration of patients with sarcoidosis in the case of a favorable course of the pathology can generally last for 2-3 years, but in the case of severe Beck’s sarcoidosis this registration can last for 5 years.

A disease such as pulmonary sarcoidosis has a relatively benign course. However, if this kind pathological process If left untreated, the sick person may experience all sorts of serious complications caused by the disease, which in some cases can lead to death.

– a disease belonging to the group of benign systemic granulomatosis, occurring with damage to the mesenchymal and lymphatic tissues of various organs, but mainly the respiratory system. Patients with sarcoidosis are concerned about increased weakness and fatigue, fever, chest pain, cough, arthralgia, and skin lesions. In the diagnosis of sarcoidosis, radiography and CT of the chest, bronchoscopy, biopsy, mediastinoscopy or diagnostic thoracoscopy are informative. For sarcoidosis, long-term treatment courses with glucocorticoids or immunosuppressants are indicated.

General information

Pulmonary sarcoidosis (synonyms Beck's sarcoidosis, Besnier-Beck-Schaumann disease) is a multisystem disease characterized by the formation of epithelioid granulomas in the lungs and other affected organs. Sarcoidosis is a disease predominantly of young and middle-aged people (20-40 years), often female. The ethnic prevalence of sarcoidosis is higher among African Americans, Asians, Germans, Irish, Scandinavians, and Puerto Ricans.

In 90% of cases, sarcoidosis of the respiratory system is detected with damage to the lungs, bronchopulmonary, tracheobronchial, and intrathoracic lymph nodes. Also quite common are sarcoid lesions of the skin (48% - subcutaneous nodules, erythema nodosum), eyes (27% - keratoconjunctivitis, iridocyclitis), liver (12%) and spleen (10%), nervous system (4-9%), parotid salivary glands (4-6%), joints and bones (3% - arthritis, multiple cysts of the digital phalanges of the feet and hands), heart (3%), kidneys (1% - nephrolithiasis, nephrocalcinosis) and other organs.

Causes of pulmonary sarcoidosis

Thus, today there is reason to consider sarcoidosis a disease of polyetiological origin associated with immune, morphological, biochemical disorders and genetic aspects. Sarcoidosis is not a contagious (i.e., infectious) disease and is not transmitted from its carriers to healthy people. There is a certain trend in the incidence of sarcoidosis in representatives of certain professions: agricultural workers, chemical workers, healthcare workers, sailors, postal workers, millers, mechanics, firefighters due to increased toxic or infectious exposure, as well as smokers.

Pathogenesis

As a rule, sarcoidosis is characterized by a multiorgan course. Pulmonary sarcoidosis begins with damage to the alveolar tissue and is accompanied by the development of interstitial pneumonitis or alveolitis, followed by the formation of sarcoid granulomas in the subpleural and peribronchial tissues, as well as in the interlobar grooves. Subsequently, the granuloma either resolves or undergoes fibrotic changes, turning into an acellular hyaline (vitreous) mass.

Classification

Based on the obtained radiological data, three stages and corresponding forms are distinguished during pulmonary sarcoidosis.

Stage I(corresponds to the initial intrathoracic lymphoglandular form of sarcoidosis) - bilateral, often asymmetrical enlargement of bronchopulmonary, less often tracheobronchial, bifurcation and paratracheal lymph nodes.

Stage II(corresponds to the mediastinal-pulmonary form of sarcoidosis) - bilateral dissemination (miliary, focal), infiltration of lung tissue and damage to the intrathoracic lymph nodes.

Stage III(corresponds to the pulmonary form of sarcoidosis) - pronounced pneumosclerosis (fibrosis) of the lung tissue, there is no enlargement of the intrathoracic lymph nodes. As the process progresses, the formation of confluent conglomerates occurs against the background of increasing pneumosclerosis and emphysema.

According to the clinical and radiological forms and localization encountered, sarcoidosis is distinguished:

Intrathoracic lymph nodes (HTNL)
Lungs and VGLU
Lymph nodes
Lungs
Respiratory system, combined with damage to other organs
Generalized with multiple organ lesions

Symptoms of pulmonary sarcoidosis

The development of pulmonary sarcoidosis may be accompanied by nonspecific symptoms: malaise, anxiety, weakness, fatigue, loss of appetite and weight, fever, night sweats, sleep disturbances. In the intrathoracic lymphoglandular form, half of the patients have an asymptomatic course of pulmonary sarcoidosis, the other half have clinical manifestations in the form of weakness, pain in the chest and joints, cough, fever, erythema nodosum. Percussion reveals bilateral enlargement of the roots of the lungs.

The course of the mediastinal-pulmonary form of sarcoidosis is accompanied by cough, shortness of breath, and chest pain. On auscultation, crepitus and scattered wet and dry rales are heard. Extrapulmonary manifestations of sarcoidosis are also present: lesions of the skin, eyes, peripheral lymph nodes, parotid salivary glands (Herford syndrome), bones (Morozov-Jungling symptom). The pulmonary form of sarcoidosis is characterized by shortness of breath, cough with sputum, chest pain, and arthralgia. The course of stage III sarcoidosis is aggravated by clinical manifestations of cardiopulmonary failure, pneumosclerosis and emphysema.

Complications

The most common complications of pulmonary sarcoidosis are emphysema, broncho-obstruction syndrome, respiratory failure, and cor pulmonale. Against the background of pulmonary sarcoidosis, the addition of tuberculosis, aspergillosis and nonspecific infections is sometimes noted. Fibrosis of sarcoid granulomas in 5-10% of patients leads to diffuse interstitial pneumosclerosis, up to the formation of “honeycomb lung”. Serious consequences threaten the appearance of sarcoid granulomas of the parathyroid glands, causing disturbances in calcium metabolism and the typical clinical picture of hyperparathyroidism, including death. If diagnosed late, sarcoid eye disease can lead to complete blindness.

Diagnostics

Characteristic changes in sarcoidosis are revealed by X-ray of the lungs, during CT or MRI of the lungs - a tumor-like enlargement of the lymph nodes is determined, mainly at the root, the “backstage” symptom (superimposition of the shadows of the lymph nodes on each other); focal dissemination; fibrosis, emphysema, cirrhosis of lung tissue. In more than half of patients with sarcoidosis, a positive Kveim reaction is determined - the appearance of a purplish-red nodule after intradermal injection of 0.1-0.2 ml of specific sarcoid antigen (substrate of the patient's sarcoid tissue).

When performing bronchoscopy with a biopsy, indirect and direct signs of sarcoidosis can be detected: dilation of blood vessels at the mouths of the lobar bronchi, signs of enlarged lymph nodes in the bifurcation zone, deforming or atrophic bronchitis, sarcoid lesions of the bronchial mucosa in the form of plaques, tubercles and warty growths. The most informative method for diagnosing sarcoidosis is histological examination of a biopsy obtained during bronchoscopy, mediastinoscopy, core biopsy, transthoracic puncture, open lung biopsy. Morphologically, the biopsy specimen reveals elements of an epithelioid granuloma without necrosis and signs of perifocal inflammation.

Treatment of pulmonary sarcoidosis

Treatment of sarcoidosis is carried out by prescribing long courses (up to 6-8 months) of steroid (prednisolone), anti-inflammatory (indomethacin, acetylsalicylic acid) drugs, immunosuppressants (chloroquine, azathioprine, etc.), antioxidants (retinol, tocopherol acetate, etc.). Prednisolone therapy is started with a loading dose, then the dosage is gradually reduced. In case of poor tolerability of prednisolone, the presence of undesirable side effects, or exacerbation of concomitant pathology, sarcoidosis therapy is carried out according to an intermittent regimen of glucocorticoids every 1-2 days. During hormonal treatment, a protein diet with limited salt, potassium supplements and anabolic steroids are recommended.

I – patients with active sarcoidosis:
IA – diagnosis established for the first time;
IB – patients with relapses and exacerbations after a course of primary treatment.
II – patients with inactive sarcoidosis (residual changes after clinical and radiological cure or stabilization of the sarcoid process).

Dispensary registration for favorable development of sarcoidosis is 2 years, in more severe cases – from 3 to 5 years. After treatment, patients are removed from the dispensary register.

Prognosis and prevention

Pulmonary sarcoidosis is characterized by a relatively benign course. In a significant number of people, sarcoidosis may not produce clinical manifestations; in 30% it goes into spontaneous remission. The chronic form of sarcoidosis resulting in fibrosis occurs in 10-30% of patients, sometimes causing severe respiratory failure. Sarcoid eye disease can lead to blindness. In rare cases of generalized, untreated sarcoidosis, death can occur. Specific measures to prevent sarcoidosis have not been developed due to unclear causes of the disease. Nonspecific prevention consists of reducing the exposure of the body to occupational hazards in people at risk and increasing the body's immune reactivity.

A disease that is widespread throughout the world and easily affects both adults and children - pulmonary sarcoidosis, its symptoms and treatment are quite complex and often cause many difficulties. Medical statistics say that most often the female sex suffers from the disease, and this happens at a young age; in older women it is quite rare. In order to start fighting the disease in a timely manner, you need to know what it is, what medications doctors recommend, and whether herbal formulations can be used to effectively get rid of the problem.

Sarcoidosis of the lungs and intrathoracic lymph nodes - what is it?

What is sarcoidosis of the lungs and intrathoracic lymph nodes, and which organs are primarily affected? This disease is quite dangerous and, if left untreated, can cause serious complications for a person. At the initial stages, a small granuloma appears in the affected organs, which grows every day if counteraction is not immediately applied. This nodule is inflammatory in nature, it is often mistaken for tuberculosis and incorrect treatment is used, aggravating the situation.

Most often, pulmonary sarcoidosis, which must be treated immediately, develops in the lung tissue, but it happens that the damage spreads to other important organs, which leads to an exacerbation. The lymph nodes located inside the chest, the spleen, and even the liver can be affected. It happens that the inflammatory process spreads to the skin, bone tissue, even in the organs of vision.

How sarcoidosis of the lungs announces itself, symptoms

Is it possible to independently determine pulmonary sarcoidosis, and how can you cope with the disease without the help of a doctor? Doctors warn that despite the fact that, by being observant, it is possible to recognize the lesion, without an accurate diagnosis from a doctor better application do not start any compositions.

Sarcoidosis of the lungs, symptoms:

feverish state;
sudden weight loss;
complete lack of appetite;
causeless fatigue, lethargy;
pain in the chest;
sleep disorders;
prolonged dry cough;
difficulty breathing.

The disease does not always manifest itself with any signs - it is often possible to recognize it only with fluorography or radiography, which is carried out during a routine examination.

Sarcoidosis of the lungs, prognosis for life

How dangerous can pulmonary sarcoidosis be for a person, the prognosis for life, what consequences can be expected if medications are used incorrectly or untimely? Modern medicine offers many drugs that can easily cope with the disease, but only on the condition that they are taken without delay, in the first stages of the lesion. Of course, it is possible to cope with the disease even in advanced forms, but here you will need the help of powerful medications.

Medicine cannot explain one phenomenon - it happens that even without drugs or herbal compositions, the disease disappears on its own. This usually happens in people with increased body resistance, otherwise many problems may develop, one of which is difficulty breathing, constant shortness of breath. Cough attacks will also not remain without consequences and will develop into a chronic form.

What drugs are prescribed if sarkidosis of the lungs develops, treatment

If a doctor has diagnosed pulmonary sarcidosis, treatment does not begin immediately; several months often pass, during which the specialist monitors the development of the disease. Immediate therapeutic intervention occurs in one case - if the lesion spreads quickly and threatens the patient’s health.

After the physician has made sure that aggressive measures are not needed, he can prescribe the use of simple formulations. The most commonly used are steroids and anti-inflammatory drugs. Additionally, a specialist may prescribe antidepressants or antioxidants. The patient must be registered, and the treatment of the disease occurs under the strict supervision of a doctor. Only after complete recovery (this can happen after several years) can the doctor decide to remove the patient from the register.

Sarcoidosis of the lungs of the 2nd degree - what can threaten the patient

How dangerous is stage 2 pulmonary sarcoidosis for health, and how important is it not to delay treatment? Doctors warn that you should not delay your visit to doctors, since the rapid development of damage to the lung tissue can lead to dangerous surprises. It is possible to cope with them, but it is quite difficult, because you will have to act on almost all the signs that may appear during the course of the disease.

Signs indicating the 2nd degree of the disease:

fever;
profuse sweating;
dyspnea;
fatigue, and it can manifest itself even in the absence of physical activity;
intense cough;
expectoration, blood blotches are observed in the sputum;
Without special tools, you can hear wheezing and whistling in the chest.

Often this degree of the disease is mistaken for tuberculosis, using appropriate treatment. Incorrect use pharmaceutical drugs or homemade formulations can lead to the development of stage 3 disease, which is accompanied by additional signs that are no less dangerous.

How dangerous is pulmonary sarcoidosis for others, is it contagious or not?

A question that often arises among people who have encountered this disease for the first time and do not know the reasons for its development is how pulmonary sarcoidosis can affect those around them, is this disease contagious or not? Despite the fact that numerous studies have been conducted for many years, doctors cannot accurately determine which causes most often cause this disease in humans. The only thing that has been established is that the disease is not infectious in nature, therefore it is not transmitted from person to person.

It is generally accepted that lesions on the lung tissue occur in people with weakened immune system. Infections, long-term use of aggressive medical compounds, exposure to allergens - all this can leave its mark on the body's resistance to disease. The results are not difficult to predict - the development of serious diseases occurs, one of which is characterized by damage to the lung tissue.

It often happens that the disease is transmitted genetically. If there is a person in the family who has suffered from an illness, the likelihood of inheriting it increases many times over. That is why people at risk are recommended to undergo regular preventive examinations, including x-rays.

What happens when there is no effect on pulmonary sarcoidosis, exacerbation

What can happen if pulmonary sarcoidosis progresses? How dangerous is exacerbation of the disease? As medical statistics show, in most patients the disease resolves without any complications; even the absence of treatment can lead to the lesion disappearing on its own. Despite such favorable prognoses, it may happen that the disease causes severe pathologies, especially if the human body is weakened by the debilitating illness suffered and has not had time to fully recover.

A patient may develop several pathologies, each of which is dangerous in its own way and can cause serious consequences. Cases of death are rare, but they still exist, so it is better not to leave damage to the lung tissue unattended and be sure to ask for help from doctors who will recommend the most effective medicinal or folk formulations.

Among the complications that can occur during exacerbations are renal, cardiac, and respiratory failure. Bleeding from the respiratory system and severe damage to internal organs may occur.

Is there disability in pulmonary sarcoidosis?

Whether pulmonary sarcoidosis causes disability is another problem that can occur in people suffering from this disease. You should know that this disease is rare, people rarely suffer from it, and recovery can occur even without the use of drugs or folk remedies. Complications that are dangerous to health or even life rarely occur, and most often the heart suffers, respiratory organs, kidneys. It is the pathologies of these important human organs that can cause disability.

To obtain disability, it is necessary to provide not only information about the treatment, but also all x-rays confirming that it was the damage to the lung tissue that caused the pathology of important organs. Only in the case of severe complications is disability possible, but it is usually attributed to another disease that arose as a result of damage to the respiratory tract.

Nutrition for pulmonary sarcoidosis - what should be included in the menu, and what foods are strictly not recommended

You should immediately remember that nutrition does not play too significant a role in pulmonary sarcoidosis and changing the diet can only be done to increase the effectiveness of treatment, as an additional measure. Practice has proven that with a balanced diet, health improves significantly, and in some cases, recovery occurs much earlier. That is why it is better not to refuse the help of a nutritionist, who will help you figure out which foods are best to include in your diet and what to completely exclude from the menu.

You should avoid or partially reduce your consumption of the following foods or dishes:

baking;
flour;
sweets;
dairy products;
pickles;
smoked meats;
sparkling sweet water.

Be sure to actively consume vegetables, fruits, fish, and meat products. When cooking, try to use a double boiler or oven. Fried foods are not acceptable.

Vitamin E for pulmonary sarcoidosis – is it necessary to take it?

Is it necessary to take vitamin E for pulmonary sarcoidosis, and what role can it play in the development of the disease? Doctors recommend taking the drug for one purpose - to increase immunity and strengthen the body's resistance. The vitamin will not be able to cope with the disease, but regular use of the product will help activate the patient’s defenses, which will certainly affect recovery and well-being. The main thing to remember in this case is to under no circumstances start taking vitamin complex without a doctor's permission. An excess of nutrients in the body can play a negative role. That is why it is better to first consult with a doctor, who will decide to speed up treatment with a vitamin preparation.

It is not necessary to take the drug in its pure form - doctors recommend intensively consuming foods that are rich in vitamin E. Most often, all types of nuts, seeds, vegetable oil. You can introduce citrus fruits into your diet (it is recommended to take their juice, which is rich in this useful substance), tomatoes, greens.

Breathing exercises for pulmonary sarcoidosis

One of the techniques that can speed up recovery is breathing exercises for pulmonary sarcoidosis. A series of simple exercises will make it much easier general state health after the first lessons. The main thing is to strictly follow all the recommendations of specialists and not to abuse gymnastics.

You should not try to experiment and use exercises recommended for other ailments - only a doctor can individually advise which movements to give preference to. You need to remember that you should definitely start with short sessions, just a few minutes. It is imperative to monitor the patient’s health and well-being throughout the procedure. If symptoms of deterioration are observed, immediately stop continuing the course and consult the doctor who recommended the classes. The doctor should prescribe simpler movements or completely prohibit the exercises.

Treatment of pulmonary sarcoidosis with folk remedies

Is it possible to treat pulmonary sarcoidosis? folk remedies, and is it possible to completely abandon the use of medicinal compounds from the pharmacy? According to doctors, the use of herbal decoctions does not play a special role, and can only partially reduce the intensity of the main manifestations of the disease.

One of the medicines that can be used against the disease is a herbal decoction. The main component of the product is cat's claw herb. You can buy it at the pharmacy. To prepare the decoction you will need about 30 grams. vegetable raw materials and 300 ml of water. Pour boiling water over the mush from the plant, place the container on the fire and simmer, never allowing it to boil, for about a quarter of an hour. Be sure to let it sit, tightly closing the lid and wrapping it in a towel. Filter the composition only after complete cooling. Take at least five times during the day. Dosage for one dose – 30-40 ml. Store the medicine in the refrigerator.

Another medicine is prepared based on turmeric. Preparation of the product will not cause any particular difficulties - just put a pinch of powder in boiled water (100 ml) and mix the composition thoroughly. Drink in one go. You can drink turmeric-based medicine only once a day - this is quite enough to improve your general condition.

Throughout the day, you can take a decoction based on lingonberries, rowan berries, and currants. This drink is useful not only due to its beneficial effects on the respiratory organs, but also its beneficial effect on human immunity. You can prepare the decoction like a regular compote - pour boiling water over a small amount of fruit and simmer for several minutes over low heat. There are no restrictions on intake - you can drink it all day. To improve the taste, it is recommended to add a small amount of honey, but only if there is no negative reaction to bee products.

What danger can pulmonary sarcoidosis pose for a patient, symptoms and treatment, features of the course of the disease, medications and folk formulations – there are quite a few questions that can accumulate in a victim of the disease. It should be remembered that self-medication has never brought anyone any good, even if simple drugs or gentle herbal decoctions are used. It is important to promptly seek the help of a doctor who will diagnose the disease and recommend the most effective formulations for her treatment.

Save the information.

Localization of sarcoidosis

Lungs and VGLU

Extrathoracic lymph nodes

Liver and spleen

Eyes

Diagnostics

Where to treat sarcoidosis?

Treatment

Treatment of sarcoidosis - video

Folk remedies

Herbal infusions

Shevchenko mixture

Beaver gland tincture

Propolis tincture

Diet for sarcoidosis

Forecast

Prevention

Read more:

Reviews

Leave feedback

Pulmonary sarcoidosis

Pulmonary sarcoidosis

Causes and mechanism of development of sarcoidosis of the lungs

Classification of pulmonary sarcoidosis

Symptoms of pulmonary sarcoidosis

Complications of pulmonary sarcoidosis

Diagnosis of pulmonary sarcoidosis

Treatment of pulmonary sarcoidosis

Prognosis and prevention of sarcoidosis

Pulmonary sarcoidosis - treatment in Moscow

Directory of diseases

Respiratory diseases

Last news

What you need to know about pulmonary sarcoidosis?

Causes

How does the disease progress?

Symptoms

Diagnostics

Treatment

Signs, symptoms, prognosis and treatment of pulmonary sarcoidosis

A little history

Classification

Modern classification

Causes

Signs and symptoms

Diagnostics

Treatment

Complications, consequences and prevention

What it is?

Reasons for development

Classification

Symptoms and first signs

Complications

Diagnostics

How to treat pulmonary sarcoidosis

Prevention of disease complications

Causes of the disease and its mechanism of development

Stages of development of pathology and its forms

Signs accompanying the development of the disease

Method of treating pulmonary pathology

General information

Causes of pulmonary sarcoidosis

Pathogenesis

Classification

Symptoms of pulmonary sarcoidosis

Complications

Diagnostics

Treatment of pulmonary sarcoidosis

Prognosis and prevention

Sarcoidosis of the lungs and intrathoracic lymph nodes - what is it?

How sarcoidosis of the lungs announces itself, symptoms

Sarcoidosis of the lungs, prognosis for life

What drugs are prescribed if sarkidosis of the lungs develops, treatment

Sarcoidosis of the lungs of the 2nd degree - what can threaten the patient

How dangerous is pulmonary sarcoidosis for others, is it contagious or not?

What happens when there is no effect on pulmonary sarcoidosis, exacerbation

Is there disability in pulmonary sarcoidosis?

Nutrition for pulmonary sarcoidosis - what should be included in the menu, and what foods are strictly not recommended

Vitamin E for pulmonary sarcoidosis – is it necessary to take it?

Breathing exercises for pulmonary sarcoidosis