[The airways in sarcoidosis].

In a retrospective study of 152 patients with histologically proven sarcoidosis (stage I: 76 patients; stage II: 70; stage III: 6) clinical pointers towards respiratory involvement were found in 45%, morphological evidence in the form of epithelioid cell granulomatosis of the mucosa in 20%, and histological findings in the form of nonspecific inflammatory and degenerative mucosal changes in 90%. In 30% of patients there were indications of respiratory tract obstruction in the lung function tests. Circumscribed central granulomatous lesions with stenoses of a segment or lobar bronchus and resulting atelectasis were rare, seen in only three. Generalized central respiratory tract obstruction, diagnosed by an increase in airway resistance, was present in 8-17% and was stage-dependent. It correlated in a statistically significant manner with the occurrence of epithelioid-cell granulomas. Peripheral airway obstruction with involvement of the small airways, of which there was functional evidence, can be caused by peribronchial formation of granulomas, as typically seen in transbronchial lung biopsies. But these findings were not of any clinical significance nor required changes in the therapeutic regimen. Functionally precipitated airway obstruction caused by bronchospasm was not demonstrated in the inhalation carbachol provocation test. On the other hand, a subgroup of sarcoidosis patients with raised serum IgE levels had a significantly lower stimulation threshold of the respiratory tract to carbachol.