Advanced Pulmonary Sarcoidosis: Treatment and Monitoring

Sarcoidosis is a multi-system inflammatory disease that poses several challenges to clinicians involved. Detecting advanced pulmonary sarcoidosis (APS) remains crucial at presentation as well as at every clinic visit since such a form of the disease is associated with an increased risk of developing respiratory failure, pulmonary hypertension (PH), and infectious complications, particularly in immunocompromised patients. As a result, APS accounts for the majority of sarcoidosis-related deaths. In this review, we focus on the definition of APS based on the identification of prognostic factors in pulmonary sarcoidosis. Additionally, we describe monitoring strategies for the detection of any disease progression and significant complications associated with the disease prognosis, such as pulmonary hypertension. Finally, the available treatment regimens for APS are reviewed with the aim of assessing the role of treatment strategies, especially since some patients are now eligible for antifibrotic treatment.