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Thursday, December 12, 2013
Stage 4 Sarcoidosis
My husband has recently had an x-ray diagnosis of stage 4 sarcoidosis. Since that time his breathing and wheezing has become better and he is able to work out. His sarcoidosis is chronic and has always come and gone. Will it continue with this same patern? or since the x-ray diagnosis will it continue to worsen? Will he be able to continue to work (he is 59) or should he even continue to work? I am so unsure of what this means, should we continue with other tests such as biopsies or is the x-ray enough? Thank you for your help.
Dear Sir/Madam- Based on the information you have provided, it would appear that your husband has had sarcoidosis for some time now.
In some cases, like your husband's, the characteristic inflammation (granulomas) associated with sarcoidosis eventually "heals" in the form of a scar (called fibrosis). Once fibrosis occurs, the process is irreversible. However, if new inflammation can be controlled then it is likely that the lung disease will not progress as quickly.
Thus, my approach is to monitor patients with Stage 4 sarcoidosis to determine if they have any active inflammation. If so, then I treat them. If there is no evidence of inflammation and lung function is stable, no treatment is necessary.
The bottom line is that your husband's disease should be managed by an experienced lung specialist (pulmonologist). A specialist is needed to determine which tests are needed to follow the disease.
As for working, it is fine for your husband to participate in work as his condition permits. That is, he will not cause harm to himself so long as he does not experience complications such as low blood oxygen levels while working. In many cases, those with Stage 4 sarcoidosis can experience low oxygen levels during exertion, such as heavy lifting or while climbing stairs or flying in a plane. Your pulmonologist would test for that and can advise him with respect to work limitations.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University