Chest
Volume 120, Issue 1, July 2001, Pages 93-101
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Clinical Investigations
Exercise
Sarcoidosis: The Value of Exercise Testing

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Study objectives

To evaluate exercise testing for theassessment of the extent of pulmonary disease in patients withsarcoidosis.

Design

Retrospective analysis ofconsecutive patients with sarcoidosis referred to the Pulmonary Physiology Laboratory between 1992 and 1997, who completed at least 6min of progressive bicycle exercise. Resting and exercise pulmonaryfunction measurements were compared to radiographic stage ofdisease.

Setting

Pulmonary Physiology Laboratory at Washington, DC, Veterans Affairs Medical Center.

Patients

Forty-eight outpatient veterans with biopsyspecimen-proven sarcoidosis.

Results

Across allradiographic stages of sarcoidosis, total lung capacity, restingdiffusing capacity, and exercise gas exchange measurements had asignificant variance with radiographic stage. Across the earlyradiographic stage disease (stages 0 to 2), the change inalveolar-arterial oxygen pressure gradient between rest and exercise, normalized for oxygen uptake, was the most significant measurement inits variation with radiographic stage.

Conclusions

Changes in gas exchange with exercise may be the most sensitivephysiologic measurements to assess the extent of disease in earlyradiographic stages of sarcoidosis.

Section snippets

Materials and Methods

We studied sequential patients with biopsy specimen-provensarcoidosis who were referred to the Pulmonary Physiology Laboratoryfor clinical exercise testing between 1992 and 1997, who successfullycompleted 6 min of a progressive SLE test and had resting pulmonaryfunction, exercise testing, and posteroanterior and lateral chestradiographs performed within a 2-month period. Each pair of chestradiographs was examined and classified by two pulmonologists: stage 0, no radiographic abnormalities;

Results

Forty-eight individuals completed a minimum of 6 min of exercisetesting. The mean age of the subjects was 41 years, 17 were white, 24were African American, 8 were smokers, and 4 of the smokers had initial COHb measurements > 3%. No patient had clinical evidence of heartdisease. Seventeen patients were receiving treatment with one or moreof the following medications: clonidine, H2-receptor antagonists, ipratropium viametered-dose inhaler (MDI), albuterol via MDI, triamcinolone via MDI, insulin,

Discussion

We do not have a true noninvasive “gold standard” formeasuring the extent of disease in patients with pulmonary sarcoidosis. The American Thoracic Society, European Thoracic Society, and the World Association of Sarcoidosis and other Granulomatous Disorders haveissued a joint statement19 of recommendations forfollowing patients with pulmonary sarcoidosis. They recommendthat system review, physical examination, chest radiograph, andspirometry be performed regularly. These will suffice for

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