Endobronchial sarcoidosis and hyperreactive airways disease.

We read with interest the article by Shorr et al (September 2001),1 regarding the hyperreactive airway response (AHR) seen in the subgroup of nonsmoking patients with newly diagnosed sarcoidosis and endobronchial disease. Although the data are limited,1 (Table 1) if sarcoidosis is a given, the probability of the test (endobronchial biopsy) for diagnosing sarcoidosis approaches one if the patient has AHR with no other obvious etiology for AHR. In nonsmoking subjects who present with abnormal chest radiographic findings compatible with stage I sarcoidosis, the probability of getting an endobronchial biopsy compatible with sarcoidosis is about 50% if the patient eventually is found to have sarcoidosis.2 Presumably, if the patients in that study also had AHR, the probability of making a diagnosis of sarcoidosis would increase even further, and the best way to do it might be by endobronchial biopsy if there are no external lesions to sample and the Kveim test was not available.3,4 If more data back up the claim that AHR in newly diagnosed sarcoidosis almost always guarantees a diagnosis of endobronchial sarcoid, then AHR can be added to the diagnostic approach in making a diagnosis of lung disease in subjects with nondiagnostic symptoms and other indicators suggestive of sarcoidosis. In patients without a diagnosis with chest radiographic findings compatible with stage I sarcoidosis and AHR with no other cause, the leading diagnosis should probably be sarcoidosis until proven otherwise,5 assuming this preliminary study is correct. In this particular case scenario, the endobronchial biopsy would be of great value. We look forward to more studies validating the findings of Shorr et al.1