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The natural history of sarcoidosis was analyzed in 279 patients with its history of as long as 2 years among the 832 with this disease registered in the Republic of Tatarstan in 1999 to 2002. The patients were divided into 3 groups: (1) 79 (28.3%) receiving systemic glucocorticosteroids (SGS); (2) 146 (52.3%) patients having therapy without SGS; (3) 54 (19.3%) patients receiving no drug therapy, but they were followed up by a physician. There was no strong evidence for that it was expedient to use prednisolone in most of patients. Prednisolone exerted a significant effect on clinical manifestations, laboratory values, and radiation pattern in patients with sarcoidosis, but more commonly (28.9%) led to its relapses than alternative treatment and active follow-up. Patients treated with prednisolone and other drugs and those untreated showed no significant differences in the frequency of cases of a worse X-ray pattern during 28 years. It is advisable to follow an active observation policy in patients having a stable course of sarcoidosis, by restricting indications for the use of prednisolone in those who have apparently progressive or threatening extrapulmonary manifestations of the disease (heart, nervous system, eyes).

A hundred thirty eight patients with pulmonary sarcoidosis were examined for the status of the respiratory and cardiovascular systems. There is a trend for external respiratory parameters to decrease as the X-ray stage increases (by 30-50% in Stage IV). The revealed cardiovascular changes in patients with different X-ray stages did not differ significantly and there was no clear correlation with the activity of a process and external respiratory parameters. The only hemodynamic indicator clearly associated with the status of the lung was pulmonary hypertension. The involvement of the heart was ascertained not to depend on the stage and activity of sarcoidosis and on the degree of respiratory disorders clearly, which requires cardiovascular monitoring in all patients with sarcoidosis.

The investigation was undertaken to compare three bronchodilators on patients with respiratory sarcoidosis. Ninety patients (66 females and 24 males) with intrathoracic sarcoidosis were examined. X-ray stages I, II, III, and IV were seen in 48.9, 46.7, 3.3, and 1.1%, respectively. A flow-volume curve was recorded on a Masterscreen Pnevmo apparatus (Erich Jaeger) before and after inhalations of salbutamol (200 micrograms, a flask), ipratropium bromide (40 micrograms, a flask), and 1 ml of berodual solution through a Boreal nebulizer. The mean baseline values of forced expiration were normal, except for MOS75 (51.0 +/- 1.3% of the normal values). After salbutamol, the increment of MOS75 was higher than that after ipratropium (20.7 +/- 3.1% and 12.3 +/- 2.3%, respectively, p < 0.05); however, after berodual nebulization, the increase in MOS50 was greater than that after inhalation of ipratropium (17.2 +/- 1.9% versus 10.7 +/- 1.6%, p < 0.05) or salbutamol (10.1 +/- 6%, p < 0.01). The changes in these parameters in smokers and nonsmokers were similar. The one-month or more inhalation of budesonide (benacort) potentiated the bronchodilating action of salbutamol on all the parameters of forced expiration, but failed to affect the effect of ipratropium and berodual. Prednisolone did not affect the effects of bronchodilators. A combination of beta 2 agonist and inhaled steroid may be effective in intrathoracic sarcoidosis with the bronchial obstruction syndrome. The mechanism of varying action of the drugs having different mechanisms of action requires further investigations.