# Pulmonary Sarcoidosis (Referral & Initial Management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BTS Clinical Statement on Pulmonary Sarcoidosis 2020 for the regimen, with the dose from Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170): "Oral: Usual Initial doses: 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses." and, for children, "Infants, Children, and Adolescents: Oral: initial: 0.1 to 2 mg/kg/day (4 to 60 mg/m2 BSA/day), in divided doses 1 to 4 times daily." The formulary states general ranges rather than a sarcoidosis regimen; the starting dose and the taper are from the BTS statement, which is not held in this corpus. · BTS Clinical Statement on Pulmonary Sarcoidosis 2020 - Verified date: 2026-08 ## Verified against - BTS Clinical Statement on Pulmonary Sarcoidosis 2020 for the regimen, with the dose from Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170): "Oral: Usual Initial doses: 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses." and, for children, "Infants, Children, and Adolescents: Oral: initial: 0.1 to 2 mg/kg/day (4 to 60 mg/m2 BSA/day), in divided doses 1 to 4 times daily." The formulary states general ranges rather than a sarcoidosis regimen; the starting dose and the taper are from the BTS statement, which is not held in this corpus. - BTS Clinical Statement on Pulmonary Sarcoidosis 2020 - Sarcoidosis - disease-level clinical article (sarcoidosis-referral-clinical.txt) ## Treatment metadata - Prednisolone — 5 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text PULMONARY SARCOIDOSIS (REFERRAL & INITIAL MANAGEMENT) Sources: BTS Clinical Statement on Pulmonary Sarcoidosis 2020 for the regimen, with the dose from Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170): "Oral: Usual Initial doses: 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses." and, for children, "Infants, Children, and Adolescents: Oral: initial: 0.1 to 2 mg/kg/day (4 to 60 mg/m2 BSA/day), in divided doses 1 to 4 times daily." The formulary states general ranges rather than a sarcoidosis regimen; the starting dose and the taper are from the BTS statement, which is not held in this corpus. · BTS Clinical Statement on Pulmonary Sarcoidosis 2020 Review status: REVIEWED against BTS Clinical Statement on Pulmonary Sarcoidosis 2020 for the regimen, with the dose from Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170): "Oral: Usual Initial doses: 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses." and, for children, "Infants, Children, and Adolescents: Oral: initial: 0.1 to 2 mg/kg/day (4 to 60 mg/m2 BSA/day), in divided doses 1 to 4 times daily." The formulary states general ranges rather than a sarcoidosis regimen; the starting dose and the taper are from the BTS statement, which is not held in this corpus., BTS Clinical Statement on Pulmonary Sarcoidosis 2020, Sarcoidosis - disease-level clinical article (sarcoidosis-referral-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - A persistent dry cough, tiredness, and breathlessness are typical presenting complaints [breathlessness · cough · fatigue] - Painful red nodules on the skin and blurred vision from uveitis are reported symptoms [blurred vision · skin nodule] - A hoarse voice and palpable lymph nodes in the armpit and neck may be noted [hoarseness] - Aching, swollen joints, along with hearing loss, seizures, or psychiatric symptoms, round out the range described [hearing loss · seizures] - A few patients have cardiomyopathy, heart conduction problems, kidney stones, or an enlarged liver [hepatomegaly · kidney stones] SIGNS - what you find (6) - Skin lesions can be papular, maculopapular, nodular, subcutaneous, hypopigmented, or plaque- like [papules · plaques · rash · skin lesions] - The commonest lesions are papular nodules on the upper face, the nape of the neck, and old scars or tattoos [papules · scarring] - Lupus pernio, a variant of the central face, shows violet or red papules, plaques, or nodules [papules · plaques] - Erythema nodosum shows as painful shin nodules and marks Loefgren syndrome [redness] - Cutaneous lesions can turn up a decade or more after the original injury or tattoo [skin lesions] - Eye disease, mainly uveitis, is found in about half of patients TESTS (10) - Bloods may reveal anaemia, low white cells, low platelets, and raised calcium - ESR and CRP are often raised but are nonspecific - A raised alkaline phosphatase points to diffuse granulomatous liver involvement - Serum ACE, adenosine deaminase, amyloid A, and soluble IL-2 receptor levels can be checked - Chest imaging is central, ranging from plain film and CT to FDG-PET and other nuclear scans - MRI or PET is favoured when heart or central nervous system involvement is suspected - Lung function testing can show reduced gas transfer, and a restrictive pattern in advanced disease, though about 10 percent show an obstructive pattern - A DLCO under 60 percent predicted plus oxygen saturation under 90 percent on a walk test warrants a pulmonary hypertension work-up - Stage I disease on chest imaging shows bilateral hilar lymph node enlargement alone - Unexplained cough or breathlessness with a normal chest x-ray warrants high-resolution CT IF NOT THIS - what else fits (3) - Tuberculosis and cat-scratch disease from Bartonella henselae are on the differential - Lung cancer and lymphoma are considered as well - Occupational lung disease and fungal infection round out the list Source StatPearls "Sarcoidosis" - disease-level clinical article Status traced to the source above 1. PREDNISOLONE [1st line] Adult 20-40 mg once daily in the morning under specialist pulmonology supervision x 4-6 weeks initial, then gradual taper Peds Specialist pediatric pulmonology/rheumatology referral Source BTS Clinical Statement on Pulmonary Sarcoidosis 2020 for the regimen, with the dose from Egyptian National Drug Formulary - Endocrine System Drugs 2024, Prednisolone monograph (printed pages 169-170): "Oral: Usual Initial doses: 5 to 60 mg/day given in a single daily dose or in 2 to 4 divided doses." and, for children, "Infants, Children, and Adolescents: Oral: initial: 0.1 to 2 mg/kg/day (4 to 60 mg/m2 BSA/day), in divided doses 1 to 4 times daily." The formulary states general ranges rather than a sarcoidosis regimen; the starting dose and the taper are from the BTS statement, which is not held in this corpus. Why Prednisolone is a corticosteroid that suppresses the granulomatous inflammation of pulmonary sarcoidosis; it is reserved for symptomatic or progressive disease under specialist supervision, since asymptomatic early-stage disease often does not need systemic treatment. Caution Requires specialist diagnostic verification (tissue biopsy, HRCT scan, serum ACE level). Monitor for corticosteroid adverse effects (hyperglycemia, osteoporosis, hypertension, cataracts). Asymptomatic Stage I sarcoidosis often does not require systemic steroid treatment. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Sarcoidosis - disease-level clinical article (sarcoidosis-referral-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - A prophylactic implantable cardioverter-defibrillator is recommended for patients with cardiac sarcoidosis. RED FLAG - The symptoms suggestive of organ involvement that should be reported promptly are worsening dyspnea, chest pain, palpitations, syncope, visual disturbances, neurologic symptoms, or persistent fatigue. RED FLAG - Ocular involvement (uveitis, present in ~50% of patients) requires referral to an ophthalmologist and regular eye examinations. 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