Intended for healthcare professionals

Clinical Review State of the Art Review

New advances in the management of pulmonary sarcoidosis

BMJ 2019; 367 doi: (Published 22 October 2019) Cite this as: BMJ 2019;367:l5553
  1. Daniel A Culver, staff physician1,
  2. Marc A Judson, chair2
  1. 1Department of Pulmonary Medicine, Respiratory Institute, Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
  1. Correspondence to culverd{at}


Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.


  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Contributorship statement DAC and MAJ both were involved in the planning of the manuscript, literature review, and writing of the manuscript. Both authors were involved in critical review.

  • Competing interests We have read and understood the BMJ policy on declaration interests and declare the following interests: DAC received honorariums from Johnson and Johnson, aTyr, Gilead, Mallinckrodt, Boehringer Ingelheim, and Genentech for participation in advisory boards and consulting. MAJ has received grants for his institution from Mallinckrodt, aTyr, and Novartis.

  • Provenance and peer review: commissioned; externally peer reviewed.

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