Inhaled corticosteroids and pulmonary sarcoidosis

Corticosteroids are the drugs of choice for treatment of sarcoidosis. Frequently the pulmonary parenchymal lesions with impaired lung function represent the indication for starting treatment. Oral glucocorticosteroids may cause systemic side-effects and therefore treatment is often started too late in the hope of a spontaneous recovery. With the introduction of the locally potent glucocorticosteroid budesonide (Pulmicort) the active alveolitis as well as the pulmonary parenchymal lesions can be treated with only inhaled steroids and without causing systemic effects. If wanted, treatment of pulmonary sarcoidosis can therefore be started early without waiting for a possible spontaneous improvement. Systemic sarcoidosis outside the lungs cannot, however, be treated with locally administered drugs. The most rapid improvement of the pulmonary manifestations is achieved if an initial combination of oral and inhaled steroids is used for 2-3 months. Thereafter the long-term maintenance treatment can be given with only inhaled budesonide.