<p>Sarcoidosis is a systemic granulomatous disorder of unclear origin, most commonly impacting the lungs and mediastinal lymph nodes. Respiratory manifestations occur in most patients and are the main contributors to disease-related morbidity and mortality. Despite decades of clinical experience, the evidence base for treatment has historically been limited, with corticosteroids serving as first-line therapy largely on the basis of observational data and expert consensus rather than robust randomized controlled trials. This comprehensive review examines the current landscape of clinical trials for pulmonary sarcoidosis, with particular emphasis on landmark studies that have shaped contemporary treatment paradigms. Finally, we propose a vision for the future of pulmonary sarcoidosis treatment, emphasizing the need for personalized medicine approaches, validated biomarkers, and international collaborative trials. As our understanding of sarcoidosis pathophysiology deepens and new therapeutic targets emerge, the prospect of disease-modifying treatments that go beyond symptom management becomes increasingly attainable.</p>