{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:56:11Z","timestamp":1775040971661,"version":"3.50.1"},"reference-count":79,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T00:00:00Z","timestamp":1577664000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Pulmonary sarcoidosis involves the deposition of granulomas within the lung. These granulomas may affect lung function and lead to pulmonary symptoms, pulmonary dysfunction, functional impairment, and worsening of quality of life. Corticosteroids are generally highly effective in resolving the granulomatous inflammation of sarcoidosis. However, despite the effectiveness of corticosteroids, many corticosteroid-responsive patients continue to experience significant problems because of the development of fibrosis from previously active or active smoldering granulomatous inflammation, inflammatory effects from sarcoidosis unrelated to granuloma deposition in lung tissue (parasarcoidosis syndromes), and the development of significant corticosteroid-related side effects. For these reasons, the decision to treat pulmonary sarcoidosis and endpoints to measure meaningful outcomes may extend beyond considerations of pulmonary granulomatous inflammation alone. In this article, we propose a conceptual framework to describe the mechanisms by which pulmonary sarcoidosis significantly impacts patients. This conceptual framework suggests that indications for the treatment of pulmonary sarcoidosis and endpoints to assess treatment depend on the specific mechanisms that are causing functional or quality-of-life impairment (or both) in patients with pulmonary sarcoidosis. We believe that these concepts are important to clinicians treating pulmonary sarcoidosis and to clinical researchers designing pulmonary sarcoidosis trials.<\/ns4:p>","DOI":"10.12688\/f1000research.20696.1","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T07:20:05Z","timestamp":1577690405000},"page":"2149","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Developing better drugs for pulmonary sarcoidosis: determining indications for treatment and endpoints to assess therapy based on patient and clinician concerns"],"prefix":"10.12688","volume":"8","author":[{"given":"Marc A","family":"Judson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"349-56","DOI":"10.1016\/j.chest.2018.02.003","article-title":"Clinical Features of Extrapulmonary Sarcoidosis Without Lung Involvement.","volume":"154","author":"W James","year":"2018","journal-title":"Chest."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"63-78","DOI":"10.1007\/s12016-014-8450-y","article-title":"The Clinical Features of Sarcoidosis: A Comprehensive Review.","volume":"49","author":"M Judson","year":"2015","journal-title":"Clin Rev Allergy Immunol."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"111-8","DOI":"10.1080\/17476348.2017.1281745","article-title":"Strategies for identifying pulmonary sarcoidosis patients at risk for severe or chronic disease.","volume":"11","author":"M Judson","year":"2017","journal-title":"Expert Rev Respir Med."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"1191-208","DOI":"10.1080\/1744666X.2016.1196135","article-title":"Biomarkers in sarcoidosis.","volume":"12","author":"A Chopra","year":"2016","journal-title":"Expert Rev Clin Immunol."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"289-94","DOI":"10.1097\/00004836-200110000-00006","article-title":"Side effects of corticosteroid therapy.","volume":"33","author":"A Buchman","year":"2001","journal-title":"J Clin Gastroenterol."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"1123-6","DOI":"10.1183\/09031936.00156314","article-title":"Negative clinical trials in sarcoidosis: failed therapies or flawed study design?","volume":"44","author":"D Moller","year":"2014","journal-title":"Eur Respir J."},{"key":"ref-7","first-page":"280-284","article-title":"The indications for the treatment of sarcoidosis: Well\u2019s Law.","volume":"34","author":"R Baughman","year":"2017","journal-title":"Sarcoidosis Vasc Diff Lung Dis."},{"key":"ref-8","first-page":"119-27","article-title":"The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States.","volume":"29","author":"M Judson","year":"2012","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"1520-33","DOI":"10.1183\/09031936.00175511","article-title":"Management of end-stage sarcoidosis: pulmonary hypertension and lung transplantation.","volume":"39","author":"O Shlobin","year":"2012","journal-title":"Eur Respir J."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"321-31","DOI":"10.1016\/j.trsl.2012.03.005","article-title":"The clinical and immunologic features of pulmonary fibrosis in sarcoidosis.","volume":"160","author":"K Patterson","year":"2012","journal-title":"Transl Res."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"781-92","DOI":"10.1164\/rccm.200509-1518OC","article-title":"A vicious circle of alveolar macrophages and fibroblasts perpetuates pulmonary fibrosis via CCL18.","volume":"173","author":"A Prasse","year":"2006","journal-title":"Am J Respir Crit Care Med."},{"key":"ref-12","first-page":"S37-41","article-title":"Pulmonary fibrosis of sarcoidosis. 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