CHEST Guidelines-Therapy for Pulmonary Arterial Hypertension in Adults

Therapy for Pulmonary Arterial Hypertension in Adults

Pdf Summary

The "CHEST Guideline and Expert Panel Report" on therapy for Pulmonary Arterial Hypertension (PAH) in adults emphasizes updated treatment recommendations due to the evolving landscape brought about by the development of 14 new medications over recent decades. The guidelines stress prompt diagnosis and treatment, complemented by a visual algorithm to guide clinical management.<br /><br />Key summary points include:<br />1. PAH Severity Assessment: The guidelines suggest a systematic evaluation using WHO Functional Classifications (FC), exercise capacity, echocardiography, and lab and hemodynamic variables to guide therapeutic decisions.<br />2. Expert Evaluation: All PAH patients should ideally be evaluated at specialized centers before treatment initiation for optimal care and outcomes.<br />3. Collaborative Care: PAH management should involve coordinated care among local and expert physicians, potentially involving various specialists and support from allied health professionals.<br />4. Treatment Recommendations:<br />   - For treatment-naïve PAH patients with WHO FC I symptoms, monitoring for disease progression is advised, with treatment initiated upon symptom development.<br />   - For WHO FC II and III patients, initial combination therapy with ambrisentan and tadalafil is recommended.<br />   - Therapies are tailored based on the severity of symptoms, with distinct recommendations for WHO FC IV patients.<br />5. Palliative and Supportive Therapies: The incorporation of palliative care services and supervised exercise are suggested to enhance disease management.<br />6. New Developments: Recent trials highlight combination therapy's importance but underscore the need for careful selection based on individual patient circumstances.<br /><br />Additionally, the update emphasizes the importance of comprehensive evaluation at specialized centers offering expert management, reflecting evolving therapeutic strategies blending pharmacological and supportive care elements to optimize patient outcomes in PAH.

Keywords

Pulmonary Arterial Hypertension

PAH treatment

CHEST guideline

expert panel report

WHO Functional Classifications

combination therapy

specialized centers

collaborative care

palliative care

exercise capacity