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Bronchial Hyperresponsiveness in Sarcoidosis

30. oktober 2026 oppdatert av: Agata Lewandowska, Bydgoszcz University of Science and Technology

The Impact of Bronchial Hyperresponsiveness and Asthma on Quality of Life in Patients With Sarcoidosis, Taking Into Account Radiological Phenotypes and Stages of Sarcoidosis

Pulmonary sarcoidosis may be accompanied by obstructive ventilatory defects and bronchial hyperresponsiveness (BHR), which can mimic the clinical presentation of asthma. In clinical practice, bronchial challenge tests are used as an adjunctive tool in the diagnosis of asthma in patients with suggestive symptoms but normal spirometry results. However, BHR is not specific to asthma and is also observed in patients with sarcoidosis. Further research is warranted by reports suggesting an association between BHR and the severity of respiratory symptoms in patients with pulmonary sarcoidosis. To assess the prevalence of BHR in the course of sarcoidosis and identify factors associated with its occurrence, methacholine bronchial challenge tests were performed in patients with sarcoidosis.

Despite the existing hypotheses explaining the presence of bronchial hyperresponsiveness in sarcoidosis, its pathogenesis remains largely unknown. The use of a methacholine bronchial challenge test and the assessment of its association with pulmonary radiological findings may help identify patients with sarcoidosis who are at increased risk of bronchial hyperresponsiveness, as well as improve our understanding of the mechanisms underlying its development.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

This was an observational, analytical, cross-sectional study with a retrospective component. The prospective component of the study assessed BHR using methacholine bronchial challenge testing in patients with established sarcoidosis.

Of the 81 patients with sarcoidosis assessed for eligibility, 70 were ultimately included in the study, having met all inclusion criteria and none of the exclusion criteria. The study protocol was developed in accordance with ATS/ERS recommendations. A 2-minute tidal breathing method with continuous inhalation of progressively increasing methacholine concentrations was used. Patients who exhibited less than a 20% decline in FEV1 at concentrations above 16 mg/ml were classified as having normal bronchial responsiveness. Based on the methacholine bronchial challenge test results, participants were classified into two groups according to the presence or absence of bronchial hyperresponsiveness. The groups were subsequently compared with respect to restrospectively obtained data (age, gender, smoking status, comorbidities, laboratory parameters, and skin prick test results to inhalant allergens). Assessed laboratory parameters included C-reactive protein serum levels, ionized and total serum calcium, and 24-hour urinary calcium excretion.

The groups were additionally compared with respect to the radiological findings (obtained retrospectively). Radiological phenotypes were classified according to the predominant pattern of pulmonary abnormalities observed on chest HRCT, using a seven-category (1-7) Delphi HRCT Phenotype Classification designed in 2024. Sarcoidosis stages were determined according to the Scadding classification (stages 0-IV), both at the time of initial diagnosis and at the time of methacholine challenge testing. HRCT findings were used to improve the accuracy of radiological assessment compared to conventional chest radiography. Changes in pulmonary parenchymal abnormalities over time were classified as radiological progression, regression, stability, or de novo presentation. This assessment was based on chest HRCT examinations performed at the time of methacholine challenge testing and compared with previous examinations obtained 6-12 months earlier during follow-up hospital admissions. Patients diagnosed with sarcoidosis less than one week before methacholine challenge testing were classified as de novo cases, whereas patients diagnosed at least six months earlier were classified as having pre-existing sarcoidosis. Radiological phenotypes, Scadding stages, and changes in radiological findings over time were jointly assessed by two pulmonologists and one radiologist. Consensus was reached on all classifications reported in the study.

In the group with a positive metacholine test result, the analysis included an assessment of bronchial hyperresponsiveness severity in relation to all the parameters.

Studietype

Observasjonsmessig

Registrering (Faktiske)

70

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

      • Bydgoszcz, Polen, 85-681
        • Clinical Department of Pulmonology, Allergology and Pulmonary Oncology, 10th Military Clinical Hospital with Polyclinic in Bydgoszcz, Poland

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

Patients under the care of the Clinical Department of Pulmonology, Allergology, and Pulmonary Oncology at the 10th Military Clinical Hospital with Polyclinic in Bydgoszcz, Poland (between 11.2024 - 12.2025).

Beskrivelse

Inclusion Criteria:

  • a confirmed diagnosis of sarcoidosis according to current ATS/ERS/WASOG guidelines,
  • availability of the required medical records,
  • ability to perform technically acceptable spirometry,
  • provision of written informed consent to participate in the study

Exclusion Criteria:

  • refusal to participate,
  • contraindications to methacholine bronchial challenge testing,
  • use of medications that could affect respiratory function without an adequate withholding period,
  • a prior diagnosis of asthma,
  • a respiratory tract infection within 8 weeks before the planned bronchial challenge test,
  • age under 18 years,
  • pregnancy and breastfeeding

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Observasjonsmodeller: CASE_CROSSOVER
  • Tidsperspektiver: PROSPECTIVE

Kohorter og intervensjoner

Gruppe / Kohort
Intervensjon / Behandling
Group with bronchial hyperresponsiveness

Participants who exhibited at least a 20% decline in FEV1 at matacholine concentrations <16 mg/ml.

The metacholine challenge test protocol was developed in accordance with ATS/ERS recommendations. A 2-minute tidal breathing method with continuous inhalation of progressively increasing methacholine concentrations was used. Patients who exhibited less than a 20% decline in FEV1 at concentrations above 16 mg/ml were classified as having normal bronchial responsiveness. A provocative concentration of methacholine causing a 20% reduction in FEV1 (PC20) of 4-16 mg/ml was considered indicative of borderline BHR. Positive bronchial challenge responses were further classified according to the PC20 value as mild (1-4 mg/ml), moderate (0.25-1 mg/ml), or marked (< 0,25 mg/ml).

Group without bronchial hyperresponsiveness

Participants who exhibited less than a 20% decline in FEV1 at matacholine concentrations above 16 mg/ml.

The metacholine challenge test protocol was developed in accordance with ATS/ERS recommendations. A 2-minute tidal breathing method with continuous inhalation of progressively increasing methacholine concentrations was used. Patients who exhibited less than a 20% decline in FEV1 at concentrations above 16 mg/ml were classified as having normal bronchial responsiveness. A provocative concentration of methacholine causing a 20% reduction in FEV1 (PC20) of 4-16 mg/ml was considered indicative of borderline BHR. Positive bronchial challenge responses were further classified according to the PC20 value as mild (1-4 mg/ml), moderate (0.25-1 mg/ml), or marked (< 0,25 mg/ml).

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Prevalence of bronchial hyperresponsiveness in patients with sarcoidosis
Tidsramme: Periprocedural

The metacholine challenge tests were performed in all included participants (N=70). Eleven participants had been excluded earlier because they met the exclusion criteria, and therefore were not enrolled in the study.

Periprocedural

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Correlation Between the Presence and Severity of Bronchial Hyperresponsiveness, Selected Laboratory Parameters and Atopy in Sarcoidosis
Tidsramme: Periprocedural

Data were obtained from the medical records of all included patients for laboratory parameters (N = 70) and from 63 patients for skin prick test results.

Periprocedural
Correlation Between the Presence and Severity of Bronchial Hyperresponsiveness and Pulmonary Radiological Findings in Sarcoidosis
Tidsramme: Through study completion, an average of 1 year

Data was obtained from medical records of all included patients (N=70).

Through study completion, an average of 1 year

Samarbeidspartnere og etterforskere

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Sponsor

Etterforskere

  • Hovedetterforsker: Cezary Rybacki, PhD, Faculty of Medicine, Bydgoszcz University of Science and Technology, Bydgoszcz, Poland

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

1. november 2024

Primær fullføring (Faktiske)

31. desember 2025

Studiet fullført (Faktiske)

31. desember 2025

Datoer for studieregistrering

Først innsendt

23. oktober 2026

Først innsendt som oppfylte QC-kriteriene

30. oktober 2026

Først lagt ut (Faktiske)

5. november 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

5. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

30. oktober 2026

Sist bekreftet

1. oktober 2026

Mer informasjon

Begreper knyttet til denne studien

Andre studie-ID-numre

  • 6/2024/KB

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NEI

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