INHALED BUDESONIDE FOR MAINTENANCE TREATMENT OF PULMONARY SARCOIDOSIS

Forty-seven patients with pulmonary sarcoidosis stage II-III, fulfilli ng clinical indications for starting treatment with corticosteroids, r eceived oral methylprednisolone for 8 weeks in gradually decreasing do ses (starting dose 48 mg per day). From week 5 onwards, they also rece ived inhaled budesonide, 1.6 mg daily. Treatment was continued for 18 months and all patients have been followed for at least 3 years. At 18 months treatment could be discontinued in 38 patients, who had used i ndividually adjusted doses of budesonide depending on the clinical res ponse (reduced doses in 14, initial dose in 16, and increased doses in 8 patients). Budesonide treatment alone was satisfactory in 31 of the se 38 cases. An additional seven patients could stop treatment after r eceiving supplementary courses of oral steroids for 3-12 months. Treat ment is ongoing in 9 patients in which 6 have extrapulmonary manifesta tions requiring oral steroids. The chest radiograph became normal in 2 2 patients and improved in 14. Significant improvements were noted in FVC and DL(co) in relation to predicted normal values. Serum ACE, lyso zyme and beta-microglobulin values decreased significantly. Transient cough was seen in 5 and hoarseness in 3 patients. No systemic side-eff ects were noted; one patient taking 2.4 mg budesonide daily had a plas ma cortisol value below the normal range. Inhaled budesonide seems to offer an effective and safe alternative to oral steroids for long-term maintenance treatment of patients with pulmonary sarcoidosis.