Clinics in chest medicine
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Clinics in chest medicine · Dec 2013
ReviewParenteral and inhaled prostanoid therapy in the treatment of pulmonary arterial hypertension.
Since continuous IV epoprostenol was approved in the U. S., parenteral prostanoid therapy has remained the gold standard for the treatment of patients with advanced pulmonary arterial hypertension (PAH). ⋯ The varied routes of administration allow for the incremental use of this class of agents in advanced PAH, and if PAH progresses. Prostanoids will remain a major component of PAH therapy for the foreseeable future.
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The relationship between pulmonary hypertension and left heart disease is complex. When initial assessment suggests the presence of pulmonary hypertension, it is critical to determine its precise nature: pulmonary arterial hypertension versus pulmonary hypertension owing to left heart disease. ⋯ Treatment requires optimal therapy of the underlying left heart disease. It is uncertain whether therapies for pulmonary arterial hypertension have any role in treating pulmonary hypertension owing to left heart disease, and there are safety concerns with these agents in this population.
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Clinics in chest medicine · Sep 2013
ReviewNewer modalities in the work-up of peripheral pulmonary nodules.
Technological advances in recent years have translated into the availability of newer modalities to establish the cause of peripheral pulmonary nodules (PPN). Even though the verdict is still out on the ideal diagnostic modality, there is no doubt that the bronchoscope is becoming a popular tool in the armamentarium of physicians who deal with PPN. This article focuses on newer bronchoscopic modalities being studied for the work-up of PPN. The authors also summarize the value of established diagnostic modalities to provide a balanced perspective.
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Interventional pulmonologists are regularly asked to perform more complicated and advanced procedures, but reimbursement for the time, effort and skill involved in these procedures has not kept up with other procedural specialties. Further changes in funding and reimbursement are likely under the Affordable Care Act. Understanding and effectively using the current system of funding for interventional pulmonology practices are imperative as we adapt to changing medical needs, legislative mandates, and reimbursement policy. This article reviews the current landscape of insurance and reimbursement in health care and anticipates some changes that might be expected from implementation of the Affordable Care Act.
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Clinics in chest medicine · Sep 2013
ReviewBronchial thermoplasty: a novel therapy for severe asthma.
This article presents an overview of bronchial thermoplasty, a novel treatment for severe asthma. Within, the authors discuss the rationale for bronchial thermoplasty in severe asthma, current clinical evidence for the use of this procedure, clinical recommendations, and future directions.