Use of Roflumilast to Prevent Exacerbations in Fibrotic Sarcoidosis Patients (REFS)

Inclusion Criteria: 1. Patients with sarcoidosis as defined by the American Thoracic Society criteria 2. Patients with an FEV1/FVC ratio of less than 80% 3. Patients with fibrosis on chest x-ray and/or high resolution CT scan. 4. Patients have had at least two exacerbations of their sarcoidosis in the prior year. An exacerbation is defined as an acute event requiring increase of prednisone with or without use of antibiotics. 5. Patients must be on a stable dose of corticosteroids and other agents for their sarcoidosis at least 4 weeks prior to first visit. 6. For patients on prednisone alone, the dose has to be the equivalent of 5 mg prednisone a day. For those on other immunosuppressants, they can be on any dose of prednisone. 7. Patients must be between ages of 18 and 70 years of age. 8. Willing to take prednisone at increased dosage for exacerbations of their sarcoidosis. 9. Patients must be able to provide written informed consent to participate in the study. Exclusion Criteria: 1. Patients with known hypersensitivity to theophylline or pentoxifylline will not be eligible. Patients with dose dependent nausea from these drugs may still participate in the trial. 2. Patients will not be able to take theophylline or pentoxifylline during the time of the study. They will be allowed to take drugs for sarcoidosis including prednisone, methotrexate, azathioprine, leflunomide, hydroxychloroquine, thalidomide, infliximab, adalimumab, and rituximab. 3. Patients with serum creatinine of greater than 3 mg/dL 4. Patients with moderate or severe liver disease as defined Child Pugh class 3 or 4. 5. Patients with unstable cardiac disease 6. Patients with non cutaneous malignancy treated in the past two years. 7. Patients unable to complete the questionnaires and six minute walks detailed in the study.Women of child bearing potential unable to use adequate birth control as determined by the investigator.