Pulmonologist Manages Respiratory Involvement in Sarcoidosis
A pulmonologist (respiratory specialist) is the primary physician who manages breathing issues related to sarcoidosis, given that over 90% of patients have lung involvement. 1, 2, 3
Why Pulmonologists Lead Sarcoidosis Care
Pulmonologists serve as the reference physician for sarcoidosis management because the lungs are involved in more than 90% of cases, making respiratory manifestations the dominant clinical feature. 3, 4, 5
The respiratory specialist handles the initial diagnosis, treatment decisions, and long-term monitoring of pulmonary sarcoidosis, even though the disease can affect multiple organ systems. 3, 6
Multidisciplinary Collaboration When Needed
While the pulmonologist leads care, certain situations require additional specialists:
Cardiac involvement (arrhythmias, heart failure, sudden cardiac death risk) necessitates cardiology consultation, as cardiac sarcoidosis is a major cause of mortality. 1
Neurologic sarcoidosis requires neurology involvement for management of central nervous system granulomas. 1
Ocular involvement needs ophthalmology evaluation, as eye disease is common in sarcoidosis. 5
Severe or refractory disease should prompt referral to a sarcoidosis subspecialist, particularly when third-line biologic therapies like infliximab are being considered. 5, 6
What the Pulmonologist Does
The respiratory specialist performs comprehensive assessment including:
Pulmonary function testing measuring forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) to assess restrictive lung disease and gas exchange abnormalities. 1, 7
Chest imaging with chest radiography initially, followed by high-resolution computed tomography (HRCT) in clinically significant cases to evaluate parenchymal involvement, fibrosis, and nodular patterns. 1, 3
Bronchoscopy with bronchoalveolar lavage when needed to exclude infections or obtain tissue for histopathologic confirmation of noncaseating granulomas. 1, 8
Serial monitoring every 6-12 months with pulmonary function tests and oxygen saturation assessment at rest and with ambulation to detect disease progression versus stability. 1, 8, 9
Treatment Decisions Led by Pulmonology
Glucocorticoids (prednisone) are initiated by the pulmonologist as first-line therapy for symptomatic patients with reduced lung function, moderate-to-severe fibrosis, or high risk of disability. 1
Steroid-sparing agents like methotrexate are added as second-line therapy when glucocorticoids alone are insufficient or cause unacceptable side effects. 1
Biologic therapies such as infliximab are considered as third-line treatment for refractory disease, typically coordinated with a sarcoidosis subspecialist. 1, 9
Common Pitfall to Avoid
Do not assume all patients with sarcoidosis need treatment—many cases are self-limited and remit spontaneously without intervention. 2, 5, 6 The pulmonologist's critical role is distinguishing patients who require treatment (those with progressive symptoms, declining lung function, or high-risk features like FVC/DLCO reduction) from those who can be safely monitored without immunosuppression. 1, 6