***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND : Corticosteroids suppress disease activity in pulmonary sarcoidosis and their use produces symptomatic , radiographic , and functional improvement . There is , however , uncertainty regarding their effects on the overall natural history of the condition and long term benefit is unproven . METHODS : Patients with pulmonary radiographic shadowing due to sarcoidosis were recruited in a multicentre study . Those who , in the first six months after entry to the study , neither required prednisolone for symptoms nor showed radiographic improvement were allocated at six months to receive either long term steroid treatment ( group L ) or selective treatment ( group S ) , with regular assessment over the subsequent five years . Patients in group L were scheduled to receive steroid treatment for at least 18 months with the policy of achieving and maintaining maximal radiographic clearing , while in group S treatment was reserved for use only if warranted by later development of symptoms or deteriorating lung function . Symptoms , radiographic appearances , and respiratory function were assessed periodically during the study . RESULTS : One hundred and forty nine patients were followed : 33 required prednisolone for troublesome symptoms within six months of entry and 58 showed radiographic improvement over this period . The remaining 58 patients were allocated to groups L ( n = 27 ) and S ( n = 31 ) . Patients in group L showed greater improvements in symptoms , respiratory function , and radiographic appearances than those in group S , although the differences were not large . After adjusting for differences at the time of allocation , the average difference in vital capacity between groups L and S at final assessment was 9 % of the predicted value . Side effects of treatment were frequent but usually mild , necessitating withdrawal in only two individuals . CONCLUSIONS : After excluding those individuals who required steroids for control of symptoms , approximately half of the remaining patients with sarcoidosis and pulmonary shadowing showed spontaneous radiographic improvement during six months of observation . In those in whom the radiograph failed to improve , prolonged steroid treatment with the aim of optimising radiographic appearances result ed in a significantly better long term functional outcome Ninety patients with sarcoidosis were enrolled in a r and omized trial of the effect of three months of prednisone therapy .  Eighty-three patients completed treatment and were followed for at least a year . in thirty-seven patients with hilar lymphadenopathy alone on admission to the study , no significant difference between treated and control groups was noted either at the end of the treatment period or after a mean interval of 5.2 years . in forty-six patients with pulmonary infiltration , significant improvement was evident at the end of the treatment period but no differences between treated patients and controls were demonstrable after a mean interval of 5.4 years . Subsequent relapse or progression necessitated prednisone therapy in 38 per cent of patients receiving placebo and 24 per cent of treated patients . the prognosis was significantly better in patients entering the study with hilar adenopathy alone . These observations support the views , widely but not universally held , that prednisone exerts little Fifteen years ago we began a prospect i ve study using alternate case treatment with prednisone in patients with pulmonary function abnormalities due to sarcoidosis . Twenty-five patients were divided into treatment and control groups that were similar in sex , age , race , degree of pulmonary dysfunction , and duration of disease . Evaluation included complete spirometric studies , single-breath carbon monoxide diffusion capacity , and arterial blood gases . Follow-up studies at six months , one to two years , and ten to 15 years show no difference between the treated and untreated groups . Improvement or deterioration in pulmonary function of individual patients in the treated group was reflected in the control group , even in those patients with a diffusing capacity and forced vital capacity less than 65 percent of predicted . Data from this long-term study fail to show any benefit of short-term use of steroids in therapy for pulmonary sarcoidosis STUDY OBJECTIVE To evaluate the 5-year prognosis of patients with stage I and stage II newly detected ( < 3 months ) pulmonary sarcoidosis treated immediately after diagnosis with prednisolone for 3 months followed by inhaled budesonide for 15 months . DESIGN R and omized , double-blind , placebo-controlled , parallel-group study for 18 months . Thereafter , open follow-up without treatment . SETTING Twenty pulmonary medicine departments in Finl and . PATIENTS One hundred eighty-nine adult patients , most of them with normal lung function , were r and omized to treatment . One hundred forty-nine patients were followed up for 5 years : 79 patients with initial stage I disease and 70 patients with stage II disease . TREATMENT Oral prednisolone for 3 months followed by inhaled budesonide for 15 months ( 800 microg bid ) , or placebo tablets followed by placebo inhaler therapy . Thereafter , treatment only on an individual basis in the case of clinical deterioration . MEASUREMENTS Yearly follow-up visits with chest radiographs , lung function tests ( FEV(1 ) , FVC ) , diffusion capacity of the lung for carbon monoxide ( DLCO ) , serum angiotensin-converting enzyme ( SACE ) , and serum and urinary calcium measurements . RESULTS No initial differences were observed in chest radiographic findings between the active-treatment and placebo-treatment groups , either in patients with initial stage I or stage II(-III ) disease . However , after the 5-year follow-up , 18 steroid-treated patients ( 26 % ) and 30 placebo-treated patients ( 38 % ) still had remaining chest radiographic changes . Placebo-treated patients more frequently required treatment with corticosteroids during the 5-year follow-up ( p < 0.05 ) . Steroid-treated patients with initial stage II(-III ) disease improved more in FVC and DLCO ( p < 0.05 ) . No differences in reported adverse events or in SACE , serum calcium , or urinary calcium values were seen . CONCLUSION Immediate treatment of pulmonary stage II(-III ) sarcoidosis-but not stage I disease-improved the 5-year prognosis with regard to lung function variables 117 patients with histologically confirmed mediastino-pulmonary sarcoidosis stage I and II without extrapulmonary manifestations were included in a controlled therapeutic trial . 92 patients remained for analysis . Among these 54 were treated for 6 or 12 months with prednisolone and isoniacid ; 38 were not treated . 6 and 12 months after beginning the observation , improvement was more frequent in the treated group . After 3 years and 5 years ( 45 patients only ) however differences were no more evident : improvement was observed in about 80 per cent , complete remission in about 65 per cent in treated and untreated patients . In both groups , patients presenting dissemination in the lungs had worse results than those with hilo-mediastinal adenopathy associated or not with pulmonary dissemination . Prednisolone seems to have effects in the early phase of sarcoidosis but is apparently not so effective in respect to the general development of the illness and in preventing pulmonary fibrosis . Therefore strict indication for therapy with corticosteroids of sarcoidosis exist when progressive pulmonary dissemination and /or reduction of pulmonary function is evident The aim of this investigation was to compare inhaled budesonide with oral prednisone in maintenance treatment of pulmonary sarcoidosis . A double-blind controlled study was performed in 40 patients with stage II or III pulmonary sarcoidosis . After initial systemic 6 weeks treatment with prednisone ( 40 reduced to 20 mg daily ) patients were allocated either to the systematic ally ( S ) or topically ( T ) treated group . S patients continued with 10 mg prednisone daily , T patients were given inhaled budesonide 1.6 mg daily . The progress of treatment was assessed by serial radiography , spirometry , serum Angiotensin Converting Enzyme ( ACE ) activity and plasma cortisol levels .  All patients completed the 12 months treatment . Using the numerical score to assess changes on the chest radiograms S patients improved by 1.7 + /- 0.66 points ; T patients improved by 1.15 + /- 0.81 points . Spirometric changes were not statistically significant . Serum ACE fell from 107 + /- 51 U/L in the S group and 92 + /- 40 U/L in the T group to 46 + /- 11 U/L and 38 + /- 21 U/L respectively during the initial phase of treatment . In the maintenance phase ACE levels remained lower than the initial ones in both groups . Morning plasma cortisol levels studied in 10 patients ( 5 in each group ) decreased significantly during the initial phase . Thereafter cortisol levels remained low in the S patients returning to the lower limit of normal values in the T patients . We conclude that inhaled budesonide may be a safe and effective alternative to oral steroids in the maintenance treatment of pulmonary sarcoidosis especially in the early stage of the disease Pulmonary sarcoidosis is a disease in which the pathological processes are distributed along lymphatic pathways , particularly those around the bronchovascular bundles . Delivery of disease-modulating drugs by the inhaled route is therefore an attractive option . The aim of this study was to determine the efficacy of inhaled fluticasone propionate 2 mg x day(-1 ) in adults with stable pulmonary sarcoidosis . Forty-four adult patients ( 22 from each centre ) were enrolled from outpatient clinics in two London teaching hospitals in a two centre , double-blind , r and omized , placebo-controlled trial . Primary end points were home recordings of peak expiratory flow rate ( PEFR ) , forced expiratory volume in one second ( FEV1 ) , and forced vital capacity ( FVC ) . Secondary end points were symptom scores , use of rescue bronchodilator medication , and clinic values for PEFR , FEV1 , FVC , forced mid-expiratory flow ( FEF25 - 75 % ) , diffusion capacity of the lung for carbon monoxide ( DL , CO ) , and total lung capacity ( TLC ) . Symptom scores of cough , breathlessness and wheeze were lower in the active treatment group , but this did not reach statistical significance , and a general health perception assessment ( Short Form (SF)-36 ) showed a difference between active and placebo treatment . No significant differences were found between the two groups in any physiological outcome measure . No new adverse reactions were detected . The results of this pilot study do not show an objective benefit of inhaled fluticasone propionate in pulmonary sarcoidosis where the disease is stable and is controlled without the use of inhaled corticosteroids The aim of this investigation was to compare inhaled budesonide vs oral prednisone in the maintenance phase treatment of pulmonary sarcoidosis . Double-blind controlled study was performed in 40 patients with stage II or III pulmonary sarcoidosis . After initial systemic 6 weeks treatment with prednisone ( 40 reduced to 20 mg daily ) patients were allocated either to systematic ally ( P ) or topically ( B ) treated group . P patients continued with 10 mg prednisone daily , B patients were given inhaled budesonide 1.6 mg daily . The progress of treatment was assessed by serial radiography , spirometry , serum ACE activity and plasma cortisol levels .  All patients completed the 12 months treatment . Using a numerical score to assess changes on the chest radiograms P patients improved by 1.7 + /- 0.66 points ; B patients improved by 1.15 + /- 0.81 points . Spirometric changes were insignificant . Serum ACE fell from 107 + /- 51 U/L in the P group and 92 + /- 40 U/L in the B group to 46 + /- 11 U/L and 38 + /- 21 U/L respectively during the initial phase of treatment . In the maintenance phase ACE levels remained lower than initial ones in both groups . Morning cortisol plasma levels studied in 10 patients ( 5 in each group ) decreased significantly during the initial phase . Thereafter cortisol levels remained low in the P patients returning to the lower limit of normal values in the B patients . We conclude that inhaled budesonide may be a safe and effective alternative to oral steroids in the maintenance treatment of pulmonary sarcoidosis especially in the early , stage II , disease Thirty-nine sarcoidosis patients with pulmonary infiltrations ( stage II ) of less than 5 years duration and not treated earlier with corticosteroids were r and omly allocated for treatment with methylprednisolone for 7 months or for observation without therapy . Every other treated patient was given the drugs daily and every other followed an alternate-day regimen . After 7 months the chest radiographic finding , the forced vital capacity and the diffusion capacity for carbon monoxide were superior in the treated group . There was no difference between the two drug regimens . After 24 and 48 months no statistically significant differences between the untreated and the treated groups were found Forty-four patients with newly discovered biopsy-proven pulmonary sarcoidosis in roentgenographic stage II ( adenopathy and interstitial abnormalities ) who also had abnormal pulmonary function ( TLC and /or DCO less than 80 percent predicted ) were assigned in alternate sequence to either a daily or alternate day prednisone treatment protocol . Both groups showed statistically significant improvement in pulmonary function ( TLC , FVC , FEV1 , DCO ) at three or six months , but there were no significant differences between the two groups . Radiographic adenopathy and interstitial scores ( interpreted by blinded readers in r and om sequence according to a quantitative scale ) also showed significant improvement in both groups at three or six months , and again no significant difference was noted between the two groups . Thus , both daily and alternate day prednisone regimens were effective therapy for stage II sarcoidosis . Alternate day therapy may be the treatment of choice for those patients at high risk for significant adverse steroid effects OBJECTIVE To evaluate whether inhaled steroids in high doses might be of therapeutic value in pulmonary sarcoidosis 
    Output:
    
Inhaled steroids had no effect on CXR .
REVIEW ER 'S CONCLUSIONS Oral steroids improved the chest X-ray and a global score of CXR , symptoms and spirometry over 6 - 24 months . ,
but there is little evidence of an improvement in lung function .
There are no data beyond two years to indicate whether oral steroids have any modifying effect on long-term disease progression .
Oral steroids are indicated for patients with Stage 2 and 3 disease with moderate - severe or progressive symptoms or CXR changes .
The available data provide no guidance for the management of this disease after two years .
Short term ( less than six months ) of inhaled steroids may improved symptoms , perhaps in patients who mainly have cough