In a randomized, double-blind study 19 patients with newly-detected
pulmonary sarcoidosis were treated with either inhaled
budesonide, 800 micrograms twice daily (n = 9), or placebo (n = 10) for 8-10 weeks. Before and
after treatment, chest roentgenograms, lung function tests, bronchoalveolar lavage (BAL) and biochemical tests were performed.
Angiotensin converting enzyme (ACE) activity and beta2-microglobulin (beta 2M) concentrations were measured in serum. The same tests, as well as
albumin and
hyaluronan were measured in the BAL-fluid. The total cell number in BAL-fluid, differential counts and lymphocyte subpopulations were determined (total T- and B-lymphocytes, T-helper/inducer (OKT-4) and T-suppressor/cytotoxic (OKT-8) lymphocytes). No significant changes in chest roentgenograms or lung function tests were observed during the short study time. However, a decrease in serum ACE (p less than 0.1) and beta 2 M (p less than 0.05) as well as in BAL-
hyaluronan (p less than 0.01) was found in the
budesonide-treated patients as well as a decrease in the percentage of BAL T-lymphocytes (p less than 0.05) and the T4/T8 ratio (p less than 0.1). No significant changes were seen in the placebo group. The findings suggest that treatment with inhaled
budesonide influences biochemical and cellular findings in patients with early
sarcoidosis in the same way as treatment with systemic
corticosteroids. The results may also explain clinical effects seen in
sarcoidosis patients treated with inhaled
corticosteroids. However, further studies are required to determine the long-term clinical benefits of inhaled
steroids in
pulmonary sarcoidosis.