CHEST Guidelines-Executive-Summary

Executive-Summary_chest

Pdf Summary

The document details the guidelines developed by the American College of Chest Physicians for monitoring the use of nonsteroidal immunosuppressive drugs, particularly in patients with pulmonary diseases and lung transplant recipients. These guidelines aim to prevent and quickly recognize significant side effects from these medications. The document highlights the importance of using evidence-based recommendations while acknowledging that some recommendations for pulmonary conditions had to be abstracted from non-pulmonary studies due to the limited specific literature available.<br /><br />The guidelines stress monitoring for side effects associated with specific drug therapies, including anti-TNF-a agents, calcineurin inhibitors, antilymphocyte antibodies, IL-2 receptor antagonists, cytotoxic agents, mTOR inhibitors, and other immunosuppressive medications. Each section outlines recommendations for conducting various tests (such as CBC counts, radiographs, and liver function tests) to preemptively identify potential adverse effects like infections, hyperlipidemia, heart failure exacerbation, or drug-induced pulmonary toxicity. Special focus is given to screening for conditions like latent TB and hepatitis B before initiating certain therapies and monitoring for signs of conditions like demyelinating disease during therapy.<br /><br />Also, the guidelines emphasize that these recommendations serve as a single source based on best practices for managing these drugs safely, but they should be coordinated with other sources like package inserts and regulatory advisories. The importance of continuing research and updating the guidelines as new information becomes available is noted. Additionally, a section addresses expected drug interactions and suggests antibiotic prophylaxis regimens for patients undergoing intensive immunosuppressive treatment to reduce infections like Pneumocystis jirovecii pneumonia.<br /><br />The document concludes by highlighting the broad collaborative effort involving various experts in the compilation of these guidelines and discusses the authors’ potential conflicts of interest.

Keywords

American College of Chest Physicians

nonsteroidal immunosuppressive drugs

pulmonary diseases

lung transplant

side effects monitoring

anti-TNF-a agents

calcineurin inhibitors

evidence-based recommendations

drug interactions

antibiotic prophylaxis