To investigate the impact of tracheal mucosa involvement on the clinical features of sarcoidosis. The clinical data of sarcoidosis patients with (Group A, n = 26) and without (Group B, n = 61) tracheal mucosa involvement were evaluated retrospectively. The proportion of patients suffering from cough in Group A was 92.3%, which was significantly higher than that in Group B (49.2%). The level of serum angiotensin-converting enzyme I (SACE) in Group A (60.7 ± 27.8 IU/L) was significantly higher than that in Group B (44.5 ± 31.9 IU/L). The proportion of lymphocytes in the bronchoalveolar lavage fluid (BALF) in Group A was significantly higher than that of Group B (45.3 ± 16.8% and 36.7 ± 15.1%, respectively; P = 0.047). The ratio of CD4 to CD8 in Group A was significantly higher than that in Group B (7.6 ± 5.4 and 3.1 ± 3.2, respectively; P = 0.005). In Group A, 84.6% patients received drug treatment, with a spontaneous remission rate of 15.4%. In Group B, 50.2% patients received drug treatment and the spontaneous remission rate was as high as 49.2%. Sarcoidosis with tracheal mucosa involvement that can lead to cough and other respiratory symptoms, may be a manifestation of sarcoidosis activity, and usually requires drug treatment (including corticosteroid treatment).