Sarcoidosis of the lungs: causes, symptoms and treatment
Sarcoidosis is a rare disease. On average, in our country, out of a hundred thousand people, only five are sick with this disease. With this disease, only the lungs are usually affected. Sarcoidosis is a chronic inflammatory disease. The age of the sick is about thirty to forty years. The disease very rarely affects the body of the elderly and children.
Content:
- Sarcoidosis of the lungs - what is it?
- Sarcoidosis symptoms
- Causes of pulmonary sarcoidosis
- Types and stages of sarcoidosis
- Possible complications
- Diagnosis of pulmonary sarcoidosis
- Treatment of pulmonary sarcoidosis
Sarcoidosis of the lungs - what is it?
Sarcoidosis of the lungs is a systemic benign granulomatosis. With this disease, the lymphatic and mesenchymal tissues of the body are damaged. In addition to the respiratory system, other organs can be affected by sarcoidosis. If the lungs are affected, then granulomas begin to form in them.
The disease can develop in both young people and middle-aged people (20-40 years old). Most often women suffer from sarcoidosis. If we consider the ethnic side of the issue, then the disease most often affects African Americans, Germans, Puerto Ricans, Irish, Scandinavians and Asians.
In sarcoidosis, granulomas form in the intrathoracic lymph nodes, in the bronchi and trachea, and in the lung tissue. The skin, eyes, liver, spleen, nervous system, salivary glands, joints, heart, kidneys, etc. can also be affected.
Granulomas are represented by giant and epithelioid cells. Sometimes sarcoidosis is confused with tuberculosis, since granulomas in these diseases have a similar structure. However, with sarcoidosis, mycobacterium tuberculosis is not found inside the granulomas, and the lung tissue does not die off.
First, the patient develops single granulomas. As the disease progresses, the foci of inflammation grow and merge. This leads to the onset of the main symptoms of sarcoidosis. Organs cease to fulfill their function. Ultimately, the neoplasms dissolve, and in their place scars, represented by connective tissue, remain.
Sarcoidosis is not a contagious disease; it is not transmitted from a sick person to a healthy person.
The disease is not always limited to only lung tissue, it spreads to other organs. Sarcoidosis goes through 3 stages of development, which will be discussed in the table.
Stages of development of sarcoidosis of the lungs:
| Stages of development of the disease | Disease manifestations |
| First stage | The patient begins to damage the alveoli of the lungs. |
| Second phase | The inflammatory process progresses, affects the vessels of the alveoli, later in them scars are formed, connective tissue grows. |
| Stage three | The patient begins to form benign formations - granulomas. They affect subpleural tissues, peribronchial tissues, interlobar sulci of the lungs. |
As a result, granulomas either dissolve or lead to irreversible destruction of lung tissue. A person suffers from the fact that the lungs lose the ability to ventilate normally. This affects the respiratory function. Ventilation of the lungs becomes superficial, the pulmonary lobe subsides. This is due to the fact that the lymph nodes put pressure on the walls of the bronchi.
Treatment for sarcoidosis is long-term. To make it as effective as possible, it is important to make a diagnosis as early as possible.
Sarcoidosis symptoms
With sarcoidosis, breathing becomes difficult, particularly during exercise. Also, the symptoms of sarcoidosis include weight loss, lack of appetite, fever, and fatigue. Lethargy, muscle weakness, dry cough may occur.
With sarcoidosis, the intrapulmonary lymph nodes are affected, which, in general, does not in any way affect the health and condition of a person at first. Therefore, the disease can be detected using X-rays, and this is all despite the fact that the disease usually affects only the lungs.
Symptoms of sarcoidosis also include hemoptysis, shortness of breath, dry cough, and chest pain. If the disease has been going on for a long time and in severe form, then there is pulmonary fibrosis and a decrease in respiratory function due to inflammatory changes in the lungs.
With sarcoidosis, changes can occur in the eyes, joints, skin, and lymph nodes. If the disease is not treated, then a person can go blind. The heart, kidneys, liver, brain, and many other organs within the human body can also be affected.
Erythema is one of the specific signs of sarcoidosis. It manifests itself as reddening of the skin, as a lot of blood rushes to it.
These symptoms cannot be ignored, it is necessary to consult a doctor and find out their cause. When listening to the lungs, the doctor will hear wheezing, which may be wet, dry, or spilled.
Sometimes the doctor hears crepitus. They resemble the squeaks that occur when the alveoli collapse.
If the disease is not of the pulmonary type, then the person may suffer from the skin, eyes, lymph nodes, salivary glands.
At the last stage of the development of the disease, the patient develops symptoms of such pathologies as: emphysema, pneumosclerosis, pulmonary and heart failure.
Causes of pulmonary sarcoidosis
Sarcoidosis is a disease of unexplained etiology. Experts put forward various versions of its origin. The infectious theory boils down to the fact that the disease is provoked by fungi, mycobacteria, protozoa, histoplasm, spirochetes and other pathogenic flora.
There is a theory that sarcoidosis can be inherited, as there are known cases of the disease in the circle of blood relatives.
Experts point out some of the risk factors that increase the likelihood of developing the disease:
- Exogenous factors. They boil down to the effects of irritants on the lung tissue, for example, chemicals, dust, viruses, bacteria, etc.
- Endogenous factors. This includes pathological processes occurring within the body itself, in particular, autoimmune diseases.
Today, sarcoidosis is considered a polyetiological pathology. Its development involves a biochemical, genetic, immune and morphological component.
The professional activity of a person with diagnosed sarcoidosis deserves special attention. It has been established that people working in the agricultural industry, sailors, doctors, postal workers, firefighters, millers and mechanics most often suffer from the disease. There is also an increased risk of sarcoidosis in factory workers.
Experienced smokers are more susceptible to sarcoidosis of the lungs than non-smokers. Their lung function is weakened by the regular intake of tar, nicotine and combustion products.
Types and stages of sarcoidosis
Depending on the course of the disease, such types of sarcoidosis are distinguished as:
- Progressive.
- Delayed.
- Chronic.
- Abortive.
The disease goes through three stages of development. All of them are described in the table.
Stages of development of pulmonary sarcoidosis:
| First stage | Stage two | Third stage |
| The patient has increased paratracheal, tracheobronchial and bifurcation lymph nodes. The defeat can be asymmetric or bilateral. | The disease progresses, spreading through the vessels and lymphatic tract. Granulomas can be focal or small (miliary disease). The lung tissue begins to be replaced by a substrate with increased density. The lymph nodes continue to be affected. | Connective tissue begins to grow in the alveoli, which is further scarred. The likelihood of developing pneumosclerosis and pulmonary emphysema increases. |
Sarcoidosis differs depending on the location of the pathological process. Granulomas can begin to form in lymph nodes located in the chest, lungs, and lymph nodes at the same time, separately in the lungs. Sometimes granulomas develop in the respiratory system and other organs, or throughout the body.
Phases of disease development:
- Acute phase.
- Stabilization phase, when disease progression stops.
- The phase of regression, characterized by the reverse development of the disease.
In the regression phase, the granulomas will dissolve. The formations present in the lymphatic system and in the lungs are calcified and become dense.
Possible complications
Sarcoidosis of the lungs is accompanied by complications such as:
-
Pneumosclerosis. In this disease, normal lung tissue is replaced by connective fibers. The lungs lose their elasticity, gas exchange in them worsens, and the respiratory function suffers.
Pneumosclerosis -
Emphysema of the lungs. The partitions that exist between the alveoli are destroyed, and the alveoli themselves expand. Emphysema can be diffuse and bullous.
Emphysema of the lungs - Adhesive pleurisy. The disease is accompanied by an inflammatory process in which the pleura is involved. Adhesions are formed in it, which fix and immobilize the lung tissue. Liquid begins to accumulate inside the lungs, their volume decreases, which affects the respiratory function.
-
Fibrosis of the lungs. Scar tissue grows in the organs, they lose their elasticity, a person with fibrosis cannot breathe normally. This process is irreversible.
Adhesive pleurisy - Tuberculosis, non-specific pneumonia, aspergillosis. All of these diseases can result from sarcoidosis.
- Death. A person can die due to complications of the disease. However, this only happens when the patient is not receiving treatment.
Diagnosis of pulmonary sarcoidosis
All patients with suspected pulmonary sarcoidosis are referred for a blood test. In this case, an increase in the level of leukocytes, monocytes, ESR, lymphocytes, eosinophils will be detected. At an early stage of the development of the disease, the values of beta globulins and alpha globulins increase.
An increase in gamma globulin titers indicates that sarcoidosis is progressing.
The patient is also referred for an X-ray of the lungs. Hardware diagnostic procedures such as CT or MRI provide more information on the disease. The patient will have enlarged lymph nodes. Such a phenomenon is diagnosed as a symptom of the wings, when the shadow of one lymph node is superimposed on others.
Another study to diagnose sarcoidosis is the Kveim reaction. In this case, the patient is injected subcutaneously with 0.2 ml of sarcoid antigen and the response of the body is assessed. If a red bump appears at the injection site, this indicates sarcoidosis.
The patient may be assigned a bronchoscopy. At the same time, dilated vessels of the bronchial orifices and enlarged bifurcation lymph nodes are found. The bronchi undergo atrophic or deforming changes, showing sarcoid bumps, warts, and plaques.
During bronchoscopy, the tissues of the altered area are taken. Later they are studied under a microscope. Particles of granulomas are found in the tissues.
Treatment of pulmonary sarcoidosis
It often happens that a person who has sarcoidosis recovers on his own after a while. But at the same time, in any case, serious and careful observation by a doctor is necessary. The doctor will be able to understand the cause of the disease, the duration of the disease and prescribe the medications necessary so that the disease does not further affect the vital organs.
Without any therapy, the disease goes away on its own in about 30% of patients. The rest of the people require medication. Serious complications of the disease develop, on average, in 30% of patients.
If sarcoidosis is not promptly treated, the disease can lead to blindness and the development of respiratory failure. Doctors warn such complications when corticosteroid hormones are prescribed to a patient. The more severe the pathology, the worse the prognosis. In rare cases, pulmonary sarcoidosis is fatal.
If the disease is inactive, then the patient needs to undergo medical supervision once a year and take a chest x-ray in order to control the disease.
Sometimes sarcoidosis can be followed by unexpected remission. Therefore, the patient is not prescribed treatment immediately. The doctor observes the patient for some time, if regression does not happen within 7-8 months, then the patient is prescribed treatment. The therapy is indicated for patients with a severe course of sarcoidosis, with its active progression, with the appearance of granulomas in other organs, as well as with lesions of the thoracic lymph nodes and with large foci of inflammation.
The patient is prescribed medications for a period of six months to 8 months.
For this purpose, drugs such as:
- Steroid hormones such as Prednisolone. Treatment begins with minimal dosages. If the patient does not tolerate Prednisolone, then Dexamethasone is prescribed to him. It is taken at intervals of 2-3 days.
- Anti-inflammatory drugs: Indomethacin, Aspirin.
- Immunosuppressants: Chloroquine, Azathioprine.
- Antioxidants: Vitamin A, E, etc.
During hormone therapy, the patient must adhere to a protein diet. It is important to limit your salt intake. Also, patients are prescribed potassium preparations and anabolic steroids.
Most often, therapy is carried out on an outpatient basis. Hospitalization is rarely required. If the disease responds well to treatment, then after its completion, the person will have to be registered at the dispensary for 2-5 years.
Video: Elena Malysheva's program "How to defeat sarcoidosis?":
To prevent the development of the disease, it is necessary to quit smoking. This measure is essential in the prevention of sarcoidosis. If symptoms of pathology appear, you must contact a specialist.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
