Background and objective: To quantify the CXR using a profusion of small lung opacities score in patients with pulmonary exacerbation of sarcoidosis. In particular, the study sought to determine whether the CXR changes were a reliable indicator of disease exacerbation.
Methods: The study recruited patients with an exacerbation of pulmonary sarcoidosis, who were attending a university medical centre sarcoidosis clinic. Pulmonary exacerbation was defined as worsening pulmonary symptoms, thought to be related to sarcoidosis, that responded to an increase in corticosteroid dose. A subset of patients were identified who met the criteria of spirometric decline of >or=10% in FVC or FEV(1) from the previous (baseline) visit. Patients required a baseline CXR and spirometry and had CXR and spirometry performed at the initial assessment. Two International Labour Organisation B readers interpreted the CXR in a blinded manner.
Results: All study patients (n = 36) were African American; there were 24 patients in the 'spirometric decline' subgroup. Agreement between the B readers was moderate (kappa = 0.54, P < 0.01). The mean profusion score increased, or worsened by 1.38 points (SD = 3.60, P = 0.008) for the exacerbation group while the 'spirometric decline' group worsened by an average of 1.80 points (SD = 3.81, P = 0.031). There was too much variation for a cut-off to be identified that would reliably diagnose exacerbations. There was no significant correlation between FVC or FEV(1) and profusion score.
Conclusions: The CXR International Labour Organisation profusion score is not a reliable test to detect pulmonary exacerbations of sarcoidosis. However, a CXR may be useful to exclude other diagnostic possibilities.