Division of Pulmonary and Critical Care Medicine; Program Director, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, USA.
Division of Pulmonary and Critical Care Medicine, Albany Medical College MC-91, Albany, NY, USA.
Expert Rev Respir Med. 2020 Apr;14(4):391-403. doi: 10.1080/17476348.2020.1721284. Epub 2020 Jan 31.
: The treatment of pulmonary sarcoidosis is not standardized. Treatment involves a multi-step decision process beginning with whether treatment is warranted, determining initial therapy, then assessing when therapy requires modifications or can be discontinued.: This manuscript will address the following issues concerning the treatment of pulmonary sarcoidosis: Treatment indications, initial anti-granulomatous therapy, therapy for chronic and fibrotic disease, glucocorticoid therapy, alternative therapy to glucocorticoids, non-granulomatous therapies, and managing complications of disease. Information was obtained through a literature search of PubMed and Web of Science databases.: Although glucocorticoids are highly effective for pulmonary sarcoidosis, their potential to cause significant side effects often mandates consideration of alternative agents. As the most common indication for the treatment of pulmonary sarcoidosis is quality of life impairment, traditional objective tests of lung function and radiographic imagining often have a minor role in therapeutic decision-making. The development of pulmonary fibrosis from sarcoidosis often causes major morbidity and mortality and should be a major focus of concern.
: 肺结节病的治疗尚未标准化。治疗涉及一个多步骤的决策过程，首先是确定是否需要治疗，然后确定初始治疗方案，然后评估何时需要修改或停止治疗。本文将讨论以下与肺结节病治疗相关的问题：治疗指征、初始抗肉芽肿治疗、慢性和纤维化疾病的治疗、糖皮质激素治疗、糖皮质激素替代治疗、非肉芽肿治疗以及疾病并发症的管理。信息通过对 PubMed 和 Web of Science 数据库的文献检索获得。尽管糖皮质激素对肺结节病非常有效，但它们可能引起严重副作用，这通常需要考虑替代药物。由于治疗肺结节病的最常见指征是生活质量受损，因此传统的肺功能和影像学检查通常在治疗决策中作用不大。肺结节病引起的肺纤维化的发展常常导致严重的发病率和死亡率，应成为主要关注的焦点。
