Effects Of Pure Inhaled Corticosteroids Therapy On Patients With Pulmonary Sarcoidosis:A Meta-Analysis

Objective: Glucocorticoids are the main drugs for the treatment of sarcoidosis, but long-term systemic medication leads to unavoidable side effects, inhalation therapy can markedly reduce the adverse reaction while making full use of its local action.However,there are some contradictory results in previous studies,and most studies are of small sample size.So we undertook a meta-analysis of randomized controlled trials(RCTs) that compared purely inhaling glucocorticoids with placebo in patients with pulmonary sarcoidosis to explore the influence on lung function,imagingstage,and respiratory symptoms.Methods: In this meta-aanlysis,we included randomized controlled trials(RCTs).Searchs were conducted on PubMed,the Cochrane Library,CBM,CNKI,Wanfang database,Vip database.The following foreign language key terms were used: “ pulmonary sarcoidosis”; “glucocorticoid”; “inhalation ”;Chinese terms included “ pulmonary sarcoidosis”.All of subjects were diagnosed by biopsy of pulmonary sarcoidosis and without extrapulmonary performance, experimental group applied pure inhaled corticosteroids therapy, the control group used a placebo treatment.Observed two groups of patients with lung function, chest X-ray manifestation, differences in respiratory symptoms.Slected studies for inclusion and extracted the data,measured the quality of studies.RevMan5.3 statistical software was used to analysis the data for clarifying the effect of purely inhaling corticosteroids on lung function [forced vital capacity(FVC), forced expiratory volume in one second(FEV1), CO dispersion capacity(DLCO), serum angioenstin I converting enzyme(sACE), imaging stage and respiratory symptoms.Results:This study included 4 studies.Meta-analysis results are as follows:1. Pulmonary function: 4 studies have observed lung function, and the results suggest TLCO of the treatment group patients is higher than the control group, difference has statistical significance, but for the change of FVC, FEV1 has no significant difference compared with control group.2. Serum angiotensin I converting enzyme(sACE) level: 4 trials have discussed the effect of inhaled corticosteroids alone to sACE, the statistical analysis indicate:compared with control group, the pure inhaled corticosteroids therapy has no significant difference on sACE.3. Image staging: a total of 3 study observed the X-ray changes before and after the treatment, most of patients developde a lower imaging staging, namely the sternum performance better, but the analysis results indicate no significant difference4. Respiratory symptoms: 1 experiment indicated that the treatment group patients during simple inhaled corticosteroids therapy symptoms such as cough, dyspnea obviously improved than the control group and keep stable during the follow-up period.While the other two studies indicated that the improvement of the symptom had no significant difference between the two groups.Conclusions: 1. Pure inhaled corticosteroids can improve the dispersion function in pulmonary sarcoidosis patients, but show no significant effect on FVC, FEV1.2. Pure inhaled corticosteroids therapy can not effectively low both the imaging staging and sACE levels of sarcoidosis patients, and the impact on the disease activity is unclear.3. The present study, there is no enough evidence to suggest that inhaled corticosteroids may improve pulmonary sarcoidosis patients’ symptoms such as cough, dyspnea.4. Studies selected in this meta-analysis are small, hence more higher quality large sample RCTs are still needed to further clarify the effecte of inhaled corticosteroids in the pulmonary sarcoidosis patients.