Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey

Background: Pulmonary hypertension is a complication of chronic lung diseases (PH-CLD) associated with significant morbidity and mortality. Management guidelines for PH-CLD emphasize the treatment of the underlying lung disease, but the role of PH-targeted therapy remains controversial. We hypothesi...

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Autores principales:	Christopher A. Thomas, Justin Lee, Roberto J. Bernardo, Ryan J. Anderson, Vladimir Glinskii, Yon K. Sung, Kristina Kudelko, Haley Hedlin, Andrew Sweatt, Steven M. Kawut, Rishi Raj, Roham T. Zamanian, Vinicio de Jesus Perez
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	pulmonary hypertension chronic lung disease vasodilators survey group 3 PH Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/37a7b37894ae478fa5990c4775f90cae
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spelling	oai:doaj.org-article:37a7b37894ae478fa5990c4775f90cae2021-12-03T05:04:24ZPrescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey2296-858X10.3389/fmed.2021.764815https://doaj.org/article/37a7b37894ae478fa5990c4775f90cae2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.764815/fullhttps://doaj.org/toc/2296-858XBackground: Pulmonary hypertension is a complication of chronic lung diseases (PH-CLD) associated with significant morbidity and mortality. Management guidelines for PH-CLD emphasize the treatment of the underlying lung disease, but the role of PH-targeted therapy remains controversial. We hypothesized that treatment approaches for PH-CLD would be variable across physicians depending on the type of CLD and the severity of PH.Methods and Results: Between May and July 2020, we conducted an online survey of PH experts asking for their preferred treatment approach in seven hypothetical cases of PH-CLD of varying severity. We assessed agreement amongst clinicians for initial therapy choice using Fleiss' kappa calculations. Over 90% of respondents agreed that they would treat cases of severe PH in the context of mild lung disease with some form of PH-targeted therapy. For cases of severe PH in the context of severe lung disease, over 70% of respondents agreed to use PH-targeted therapy. For mild PH and mild lung disease cases, <50% of respondents chose to start PH-specific therapy. There was overall poor agreement between respondents in the choice to use mono-, double or triple combination therapy with PH-specific agents in all cases.Conclusion: Although management guidelines discourage the routine use of PH-targeted therapies to treat PH-CLD patients, most physicians choose to treat patients with some form of PH-targeted therapy. The choice of therapy and treatment approach are variable and appear to be influenced by the severity of the PH and the underlying lung disease.Christopher A. ThomasJustin LeeRoberto J. BernardoRyan J. AndersonVladimir GlinskiiYon K. SungKristina KudelkoHaley HedlinAndrew SweattSteven M. KawutRishi RajRoham T. ZamanianVinicio de Jesus PerezFrontiers Media S.A.articlepulmonary hypertensionchronic lung diseasevasodilatorssurveygroup 3 PHMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pulmonary hypertension chronic lung disease vasodilators survey group 3 PH Medicine (General) R5-920
spellingShingle	pulmonary hypertension chronic lung disease vasodilators survey group 3 PH Medicine (General) R5-920 Christopher A. Thomas Justin Lee Roberto J. Bernardo Ryan J. Anderson Vladimir Glinskii Yon K. Sung Kristina Kudelko Haley Hedlin Andrew Sweatt Steven M. Kawut Rishi Raj Roham T. Zamanian Vinicio de Jesus Perez Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
description	Background: Pulmonary hypertension is a complication of chronic lung diseases (PH-CLD) associated with significant morbidity and mortality. Management guidelines for PH-CLD emphasize the treatment of the underlying lung disease, but the role of PH-targeted therapy remains controversial. We hypothesized that treatment approaches for PH-CLD would be variable across physicians depending on the type of CLD and the severity of PH.Methods and Results: Between May and July 2020, we conducted an online survey of PH experts asking for their preferred treatment approach in seven hypothetical cases of PH-CLD of varying severity. We assessed agreement amongst clinicians for initial therapy choice using Fleiss' kappa calculations. Over 90% of respondents agreed that they would treat cases of severe PH in the context of mild lung disease with some form of PH-targeted therapy. For cases of severe PH in the context of severe lung disease, over 70% of respondents agreed to use PH-targeted therapy. For mild PH and mild lung disease cases, <50% of respondents chose to start PH-specific therapy. There was overall poor agreement between respondents in the choice to use mono-, double or triple combination therapy with PH-specific agents in all cases.Conclusion: Although management guidelines discourage the routine use of PH-targeted therapies to treat PH-CLD patients, most physicians choose to treat patients with some form of PH-targeted therapy. The choice of therapy and treatment approach are variable and appear to be influenced by the severity of the PH and the underlying lung disease.
format	article
author	Christopher A. Thomas Justin Lee Roberto J. Bernardo Ryan J. Anderson Vladimir Glinskii Yon K. Sung Kristina Kudelko Haley Hedlin Andrew Sweatt Steven M. Kawut Rishi Raj Roham T. Zamanian Vinicio de Jesus Perez
author_facet	Christopher A. Thomas Justin Lee Roberto J. Bernardo Ryan J. Anderson Vladimir Glinskii Yon K. Sung Kristina Kudelko Haley Hedlin Andrew Sweatt Steven M. Kawut Rishi Raj Roham T. Zamanian Vinicio de Jesus Perez
author_sort	Christopher A. Thomas
title	Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
title_short	Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
title_full	Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
title_fullStr	Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
title_full_unstemmed	Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey
title_sort	prescription patterns for pulmonary vasodilators in the treatment of pulmonary hypertension associated with chronic lung diseases: insights from a clinician survey
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/37a7b37894ae478fa5990c4775f90cae
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Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey

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