Pulmonary and psychosocial findings at enrollment in the ACCESS study.
OBJECTIVE
To assess lung involvement and the association of demographic and psychosocial factors with respiratory health in 736 persons with sarcoidosis at enrollment in A Case Control Etiologic Study of Sarcoidosis (ACCESS).


METHODS
736 patients with biopsy diagnosis of sarcoidosis within 6 months of enrollment were studied at 10 US centers. Lung involvement was evaluated by chest radiography, spirometry and dyspnea questionnaire. Demographics, number of involved extrathoracic organ systems, comorbidities, and health-related quality of life (HRQL) were assessed.


RESULTS
95% of patients had lung involvement. 8% were Scadding Stage 0, 40% I, 37% II, 10% III, and 5% IV 51% reported dyspnea. Increasing radiographic lung stage was associated with decreasing Forced Vital Capacity (FVC) (p < 0.01). Patients with higher stages had more airways obstruction and dyspnea. 46% of cases and 27% of controls had Center for Epidemiologic Studies Depression Scale (CES-D) scores of 9 or greater, (p < 0.001). Age > or = 40, African-American race, body mass index > or = 30kg/m2, and CES-D scores > 9 were associated with decreased FVC and greater dyspnea. Impaired spirometry and greater dyspnea were associated with poorer quality of life.


CONCLUSIONS
A "global" approach to the sarcoidosis patient, including careful assessment of dyspnea and health related quality of life, as well as of lung function and radiographic changes, and any extrathoracic involvement, is important, not only in management of the individual patient, but should also prove beneficial in assessing outcomes in clinical trials in the future.
Yeager
Henry
H
Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Medical Center, Washington, DC 20057, USA. yeagerh@georgetown.edu
Rossman
Milton D
MD
Baughman
Robert P
RP
Teirstein
Alvin S
AS
Judson
Marc A
MA
Rabin
David L
DL
Iannuzzi
Michael C
MC
Rose
Cecile
C
Bresnitz
Eddy A
EA
DePalo
Louis
L
Hunninghakes
Gary
G
Johns
Carol J
CJ
McLennan
Geoffrey
G
Moller
David R
DR
Newman
Lee S
LS
Rybicki
Benjamin
B
Weinberger
Steven E
SE
Wilkins
Patricia C
PC
Cherniack
Rueben
R
D000328:Adult; D001741:Black or African American / Q000208:ethnology; D001706:Biopsy; D016022:Case-Control Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011581:Psychological Tests; D011788:Quality of Life; D013902:Radiography, Thoracic; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012720:Severity of Illness Index; D013147:Spirometry; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology