By CINDY LADAGE

Illinois Correspondent

COLUMBUS, Ohio — Good news may be on the horizon for those who suffer from sarcoidosis. Preliminary research from lung experts at The Ohio State University Wexner Medical Center shows that nicotine patches may relieve the symptoms of this inflammatory lung disease.

Dr. Elliott Crouser, a pulmonologist specializing in sarcoidosis said this is a bit of a mystery disease which can affect any tissue of the body, but most often involves the lungs. “Pulmonary doctors see these patients. The inflammation characterizing this disease is referred to as a granuloma, which is a cluster of immune cells that forms a ball-like structure. The cause of sarcoidosis is unclear, but granulomas often occur in response to exposures to infectious organisms, including Mycobacterial infections such as tuberculosis or fungal diseases, or granulomas may occur in response to non-infectious exposures such as are commonly encountered in an agricultural setting.”

While pesticides are one possible cause, others include exposure to minerals and dust which the body attempts to eliminate by enclosing them in a granuloma.

“It’s tricky because sarcoidosis mimics other more common diseases, which is why it is frequently misdiagnosed, but it can also mimic pneumonia, cause scar tissue, pr be confused with lung cancer because of associated lymph node enlargement. It can involve any other vital organ and the presentation can vary greatly from one person to the next,” explained Dr. Crouser. “It is hard to predict who will get sarcoidosis, but studies show that agricultural exposures predispose to sarcoidosis, and it can run in some families suggesting a genetic component.”

Many patients with sarcoidosis do not require treatment, and they have few symptoms. However, a significant number of patients, when untreated, may experience progressive disease leading to severe lung damage and even death.

Like other lung diseases, symptoms are debilitating fatigue, and a constellation of other manifestations, such as joint pains, muscle aches, which combine to compromise overall quality-of-life. Over time, sarcoidosis can scar the lungs and in some cases patients may need a lung transplant. In some patients, sarcoidosis can affect the kidneys, brain or heart leading to loss of function in these organs.

Although the cause of sarcoidosis is unclear, Dr. Crouser feels it is prudent for agricultural workers to reduce their risk by limiting their exposure to smoke, dust, pesticides and fumes.

There is not a cure for sarcoidosis; however, there are a variety of treatments and new treatments are being actively investigated. Treatments for sarcoidosis, such as cartico steroids that reduce inflammation, often have side effects that are harsher than the symptoms of the disease itself.

“We can’t use steroids for very long before these side effects occur. They can be severe, such as the development of osteoporosis, cataracts, diabetes or high blood pressure and complications related to those,” Dr. Crouser said. “We need better, more tolerable options.”

One of those more tolerable options that is currently being explored are nicotine patches like those used to help people stop smoking. With support from the National Institutes of Health, Dr. Crouser is leading a clinical trial at Ohio State Wexner Medical Center to test nicotine patches, as a potential treatment for sarcoidosis. A small initial study of the patches showed some benefit.

“The nicotine helped normalize the immune response suggesting that it may reduce inflammation in the lungs,” he added.

Dr. Crouser is conducting a larger, randomized trial. The Cleveland Clinic is also participating in the study. “Why nicotine? Around 2000, we learned two things. There was new evidence that nicotine is an anti-inflammatory agent, and prior epidemiological studies surprisingly showed that cigarette smoking reduced the risk of developing sarcoidosis,” Dr. Crouser said.

“So we’re investigating whether nicotine can be a solution. We hope people will actually provide a secondary benefit making sarcoidosis patients who often complain of feel more energized and have better quality of life.”

The nicotine used in the trial participants is not addictive because it is released continuously, therby avoiding the highs and lows felt by those who smoke or chew tobacco. The participants are randomized to receive a patch with nicotine or a placebo for seven months.

Researchers will evaluate lung function and will also use computerized axial tomography (CAT scans) along with computer models to monitor disease progression or improvement.

Dr. Crouser and his team are still actively enrolling for this study. “My objective is to get reach out to sarcoidosis patients to make them aware of ongoing research that they may wish to engage in.”

For details, call Marti Lietch with Wexner Center Media Relations at 614-293-3737.