Sarcoidosis is a multisystemic granulomatous disorder of unknown origin, which can involve multiple organs. However the lymph node and lung manifestations dominate. Most frequent symptoms are cough, fatigue, dyspnea and exercise limitations. About one third of the patients have no symptoms. The lung function test is mostly restrictive. The clinical course is very variable, spontaneous remissions occur in about 60 %. Acute sarcoidosis is a highly inflammatory disease with a very good prognosis even without steroid therapy. Chronic pulmonary sarcoidosis can lead to progressive loss of lung function. Indications to therapy are severe symptoms and loss of lung function as well as progressive lung involvement with fibrosis pattern. In chronic disease corticosteroids are effective in the majority of patients. Other immunosuppressives, cytotoxic and immunomodulatory agents are reserved for patients with severe side-effects to steroidtherapy or for patients, who cannot maintained on reasonable low doses of steroids. Lung transplantation is an option for life-threatening cases failing medical therapy.