Comorbidities in Idiopathic Pulmonary Fibrosis 3/15/2019 ¢  Most patients with idiopathic pulmonary

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  • Comorbidities in Idiopathic Pulmonary Fibrosis: A Clinical Resource Guide A CME/CE-certified supplement to CHEST® Physician

  • 2 / COMORBIDITIES IN IDIOPATHIC PULMONARY FIBROSIS: A CLINICAL RESOURCE GUIDE

    Comorbidities in Idiopathic Pulmonary Fibrosis: A Clinical Resource Guide

    Table of Contents Learning Objectives ................................... 3

    Introduction ............................................. 3

    Pulmonary Comorbidities ............................ 3

    Pulmonary hypertension ..........................................3

    Sleep disorders ......................................................3

    Pneumonia ............................................................4

    Venous thromboembolism and pulmonary embolism ...4

    Lung cancer ...........................................................4

    Emphysema ...........................................................4

    Extrapulmonary Comorbidities ..................... 4

    GERD and hiatal hernia ........................................4

    Cardiovascular disease ............................................5

    Diabetes mellitus ....................................................5

    Depression and anxiety ...........................................6

    Short telomere syndrome ........................................6

    Resources and Websites ............................. 6

    Conclusion ................................................ 7

    References ............................................... 7

    Timothy Blackwell, MD Ralph and Lulu Owen Professor of Medicine Professor of Cell, Developmental Biology and Cancer Biology Director, Division of Allergy, Pulmonary and Critical Care Vanderbilt University Medical Center Nashville, Tennessee

    Faculty

    This activity is supported by an independent educational grant from Boehringer Ingelheim.

    Jointly provided by

    Neither the editors of CHEST® Physician nor the Editorial Advisory Board nor the reporting staff contributed to its content. The ideas and opinions expressed are those of the faculty and do not necessarily reflect the views of the supporters, American College of Chest Physicians (CHEST®), Global Academy for Medical Education, Postgraduate Institute for Medicine, or the Publisher.

    This activity is not an official program of the American College of Chest Physicians (CHEST®), and, accordingly, is not accredited by CHEST®.

    A CME/CE-certified supplement to CHEST® Physician

    Original Release Date: March 15, 2019 Expiration Date: March 15, 2020 Estimated Time to Complete Activity: 45 minutes Media: Publication Target Audience This activity has been designed to meet the educational needs of pulmonologists, radiologists, pathologists, primary care physicians, PAs, nurse practitioners, nurses, and other healthcare profes- sionals who care for patients with idiopathic pulmonary fibrosis (IPF). Learning Objectives Upon completing this activity, the participant should be better able to: • Describe comorbidities commonly occurring in IPF patients • Apply strategies to diagnose comorbidities in IPF patients • Employ best practices for engaging other members of the healthcare team when managing

    comorbidities • Review optimal treatment approaches to comorbidities in IPF patients • Apply strategies to engage patients in shared decision-making regarding the management of

    their comorbidities and IPF care Credit Available Physicians — maximum of 0.75 AMA PRA Category 1 Credit™ All other healthcare professionals completing this course will be issued a statement of participation. Joint Accreditation Statement

    In support of improving patient care, this activity has been planned and imple- mented by the Postgraduate Institute for Medicine and Catamount Medical Education. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing

    Center (ANCC), to provide continuing education for the healthcare team.

    The Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure of Conflicts of Interest The Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. Timothy Blackwell, MD: Contracted Research: Boehringer Ingelheim, Celgene Planners and Managers: PIM planners and managers have nothing to disclose. Catamount Medical Education planners and managers have nothing to disclose. Instructions for Participation and Credit There are no fees for participating and receiving CME/CE credit for this activity. During the period March 15, 2019 through March 15, 2020, participants must read the learning objectives and faculty disclosures and study the educational activity. If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation on www.cmeuniversity.com. Access the site directly or scan the bar code on the back of this publication. On the navigation menu, click on “Find Post-test/Evaluation by Course” and search by course ID 13651. Upon registering and successfully completing the post-test with a score of 80% or better and the activity evaluation, your certificate will be made available immediately. DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contrain- dications, and warnings. DISCLAIMERS Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clini- cians without evaluation of their patient‘s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer‘s product information, and comparison with recom- mendations of other authorities. CHEST® Physician is pleased to distribute this informational resource for pulmonary, critical care, and sleep medicine physicians; cardiothoracic surgeons; cardiovascular surgeons; and cardiologists, but this distribution does not convey endorsement and is not intended to replace professional medical care and physician advice, which always should be sought for any specific condition. CHEST and its officers, regents, members, and employees disclaim all liability for the accuracy or completeness of the content and disclaim all warranties, express or implied.

    Copyright © 2019 by Global Academy for Medical Education, LLC, Frontline Medical Communications Inc., and its Licensors. All rights reserved. No part of this publication may be reproduced or transmitted in any form, by any means, without prior written permission of the Publisher. Global Academy for Medical Education, LLC and Frontline Medical Communications will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein.

  • COMORBIDITIES IN IDIOPATHIC PULMONARY FIBROSIS: A CLINICAL RESOURCE GUIDE / 3

    Pulmonary hypertension Pulmonary hypertension (PH) is defined as mean arterial pressures (mPAP) at rest of 25 mm Hg or more, confirmed by right heart catherization.9 An estimated 10% of patients with IPF have mPAP values above 25 mm Hg at diagnosis, and 30% to 50% of patients with advanced IPF show evidence of PH.8,10 In patients with IPF, PH is associated with reduced survival, impaired quality of life, lower exercise tolerance, and increased need for supplemental oxygen.1,10,11

    Most of the symptoms of IPF overlap with those of PH, which makes it difficult to diagnose PH in patients with IPF.12 Signs of PH include accentuated pulmonary heart sound, tricuspid regurgitation murmur, and fixed splitting of the second heart sound.12 While some changes may be evident on cardiac CT, echocardiogram, or ECG, definitive diagnosis of PH requires right heart catherization.12 A study of 135 patients with IPF, 73 of whom also had PH, showed that the best noninvasive predictors of PH were ventilatory efficiency for CO2 (expressed as the relationship between minute ventilation [VE] and carbon dioxide output [VCO2]) and peak oxygen uptake during exercise.11

    Practice Pearl: Although there have been several trials investigating pharmacotherapies for PH in IPF, th