Topics in Lung Disease

This edition of FP Essentials covers several important lung disease topics that can have a substantial impact on our patients’ health and well-being. Early detection and proper management are key for improving outcomes and preventing complications.

Section One focuses on pulmonary hypertension, which is thought to affect about 1% of the global population and about 10% of adults older than 65 years. Because symptoms are nonspecific and overlap with other pulmonary and cardiac conditions, a high index of clinical suspicion is needed to prevent delay in diagnosis. I was interested to learn about advances in pharmacotherapy for pulmonary hypertension, including endothelin receptor antagonists, prostacyclin analogues, and phosphodiesterase 5 inhibitors. Section Two covers pulmonary nodules found incidentally and during lung cancer screening. The guidelines discussed in this section help clinicians integrate the radiographic characteristics of pulmonary nodules with the patient’s risk factors to provide evidence-based and patient-centered care. Section Three addresses obesity-hypoventilation syndrome, which causes daytime hypercapnia and can lead to substantial morbidity and mortality. Weight loss of 25% to 30%, although difficult to achieve, can provide relief. Treatment with continuous positive airway pressure or bilevel positive airway pressure helps manage hypercapnia and sleep-disordered breathing. Section Four provides information about diagnosis and management of noninfectious pleural effusions, both transudative and exudative.

I hope you find this edition of FP Essentials helpful for your practice. When you have finished studying it and are ready to submit your quiz answers, please tell us what was most useful and what we can do to improve. We also always look forward to hearing your ideas for topics you would like covered in future editions.

Karl T. Rew, MD, Associate Medical Editor
Clinical Associate Professor, Departments of
Family Medicine and Urology
University of Michigan Medical School, Ann Arbor

Alexander Kaysin, MD, MPH, FAAFP, is medical director and a faculty member for the University of Maryland (UM) Capital Region Health Family Medicine Residency Program in Largo. Actively involved in clinical practice and graduate medical education, he specializes in full-spectrum family medicine, including treatment of adults and children with acute and chronic lung diseases. He is also an associate professor of family medicine at Ross University School of Medicine in Barbados and medical director of the full-term nursery at the UM Capital Region Medical Center.

Sunil Swami, MD, is a pulmonary disease specialist, board certified in internal medicine and pulmonology. He is division chief of pulmonology, director of respiratory care, and a faculty member for the Internal Medicine Residency Program at UM Capital Region Health in Largo. In addition to clinical work, he is involved in research focused on enhancing outcomes in patients with interstitial lung diseases and pulmonary vascular disease.

Oluwatoni Aluko, MD, MPH, CAQSM, is a faculty member for the UM Capital Region Health Family Medicine Residency Program in Largo. She is also a sports medicine fellowship–trained and board-certified family medicine physician providing full-spectrum outpatient care for all life stages. She enjoys teaching and mentoring medical students and residents and is passionate about preventive health, quality improvement, and healthy equity.

Dea Sloan Bultman, MD, MPH, FAAFP, is a board-certified family medicine physician and program director for the Family Medicine Residency Program at UM Capital Region Health in Largo. In addition to her work leading curricular innovation within graduate medical education, she practices full-spectrum family medicine, including adult inpatient medicine, obstetrics and gynecology, and neonatal care. She strives to develop future generations of socially conscious physicians with sound clinical reasoning rooted in evidence-based medicine.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. All individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Consider pulmonary hypertension when evaluating patients with exertional dyspnea, progressive fatigue, syncope, pedal edema, or symptoms and signs of left-sided heart disease.
• Use echocardiography as the initial noninvasive test to evaluate for pulmonary hypertension.
• Understand the currently available pharmacotherapy treatment options for pulmonary hypertension.
• Apply evidence-based guidelines when screening for and managing pulmonary nodules.
• Recognize the features of pulmonary nodules that confer a higher risk of malignancy.
• Recommend comprehensive weight loss strategies for patients who have obesity-hypoventilation syndrome.
• Prescribe continuous positive airway pressure or noninvasive ventilation with bilevel positive airway pressure during sleep for patients with obesity-hypoventilation syndrome.
• List common causes of pleural effusions.
• Describe how to differentiate transudative and exudative pleural effusions.