These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patientoriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
1. High-dose calcium channel blockers should be prescribed for patients with idiopathic, heritable, or drug/toxin-associated pulmonary arterial hypertension with World Health Organization functional class I or II who demonstrate marked hemodynamic improvement (ie, mean pulmonary artery pressure less than 30 mm Hg and pulmonary vascular resistance less than 4 WU.)
Evidence rating: B
Source: Section One, Reference 2
2. Patients with pulmonary hypertension who are pregnant or considering pregnancy should receive prompt, multidisciplinary counseling at a specialized pulmonary hypertension center. This should include consultation with perinatology, genetic counseling, and shared decision-making to assess maternal and fetal risks. Psychological support should also be offered, regardless of whether pregnancy continuation or termination is pursued. Additionally, comprehensive contraception counseling should be offered when appropriate to support informed reproductive choices and prevent unintended pregnancies.
Evidence rating: B
Source: Section One, Reference 28
3. Management of pulmonary nodules should follow a multidisciplinary, evidence-based approach that prioritizes patient-centered care. Clinical decisions should integrate patient history and a structured assessment of imaging characteristics of nodules to estimate malignancy risk and minimize unnecessary testing.
Evidence rating: B
Source: Section Two, Reference 19
4. Patients 50 to 80 years of age with at least a 20-pack-year smoking history who currently smoke or quit within the past 15 years should be offered annual low-dose CT screening for lung cancer. The risks and benefits of screening should be discussed with patients.
Evidence rating: B
Source: Section Two, References 16 and 19
5. Continuous positive airway pressure or noninvasive ventilation with bilevel positive airway pressure should be used during sleep in patients with obesity-hypoventilation syndrome to improve ventilation and gas exchange.
Evidence rating: B
Source: Section Three, Reference 1
6. Comprehensive weight loss programs, aiming to lose 25%-30% of body weight, are recommended to reduce symptoms of obesity-hypoventilation syndrome, and address cardiovascular and metabolic risk factors.
Evidence rating: B
Source: Section Three, Reference 1
7. Therapeutic pleural interventions should not be performed in asymptomatic patients with known or suspected malignant pleural effusions.
Evidence rating: C
Source: Section Four, Reference 49
8. Imaging-guided diagnostic thoracentesis is recommended when pleural fluid thickness exceeds 10 mm and for pleural effusions of unknown etiology.
Evidence rating: C
Source: Section Four, Reference 20
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