Lymphocytic alveolitis and airway responsiveness in recently diagnosed sarcoidosis

We looked at the relationship between the intensity of the lymphocytic alveolitis and airway responsiveness to methacholine, in patients with recently diagnosed untreated pulmonary sarcoidosis. We studied 19 subjects, 13 M and 6 F, aged 19-58 (mean: 36.6) who had a diagnosis of pulmonary sarcoidosis within the last 6 months (radiologic stages: I, 10 subjects; II, 8; III, 1). One subject had a previous history of asthma but was currently asymptomatic. Five were smokers, 5 ex-smokers and 9 non-smokers. Initial assessment included a flexible bronchoscopy with bronchoalveolar lavage (BAL), measurement of expiratory flows, lung volumes, CO diffusion and a methacholine inhalation test. Pulmonary function tests were repeated six months later, and a second evaluation of airway responsiveness to methacholine was obtained in 13 patients. Mean % of lymphocytes, neutrophils and macrophages on BAL were respectively: 25.4, 2.3 and 72.4. Mean % of predicted values for FVC, FEV1, FEF25-75%, TLC, FRC and DLCO were respectively 91.3, 94.3, 88.8, 97.6, 102.1 and 91.2. In all subjects FEV1 was > or = 80% and PC20 was in the normal range (> 16 mg/ml in all subjects but one who had a PC20 of 12.0). There was no correlation between the % of BAL lymphocytes and the initial PC20. At 6 months, overall airway responsiveness was unchanged (geometric mean initial/6 month PC20 methacholine: 95.9/102.8) whether or not the subjects had a high intensity alveolitis (defined as > or = 30% lymphocytes on BAL).(ABSTRACT TRUNCATED AT 250 WORDS)