ATS Pocket Guide 2013 - (Page 23)

„ MONITORING FOR WORSENING OXYGENATION1 ■ Oxygen saturation by pulse oximetry should be measured at rest and with exertion in all patients regardless of symptoms to assure adequacy of oxygenation and identify the need for supplemental oxygen at baseline and during follow-up evaluation. ■ Careful attention to the pulse oximetry tracing and signal is required to overcome potential problems related to poor circulation and inadequate signal quality. » Generally, desaturation below 88% during a formal 6MWT or equivalent has been used to prescribe supplemental oxygen. ■ Such measurements should be performed at baseline and during follow up at 3- to 6-month intervals. ■ Formal cardiopulmonary exercise testing does not have a defined role and is not recommended for routine monitoring. „ MONITORING FOR COMPLICATIONS AND COMORBIDITIES1 Comorbidities including PH, pulmonary embolism, lung cancer, and coronary artery disease are known to occur in IPF. While the development of these comorbidities may influence survival, the role of routine screening to identify such complications (e.g., annual HRCT for lung cancer surveillance) is unknown. Thus, a recommendation for routine screening cannot be made. ■ In patients demonstrating progressive disease, the identification of PH may impact consideration for lung transplantation in eligible patients, and evaluation is indicated. » Echocardiography is not accurate in estimating pulmonary hemodynamics in patients with fibrotic lung disease and should not be relied upon to assess the presence and severity of PH. » Brain natiuretic peptide levels may correlate with the presence of moderate to severe PH, but have not been thoroughly validated as a screening tool. » A clinical prediction model has also been proposed but requires independent validation. At the present time, right heart catheterization is required to confirm the presence of PH. ■ Some patients with connective tissue disease (e.g., younger women) may present with isolated pulmonary abnormalities characteristic of IPF prior to overt manifestations of systemic disease, appropriate serological monitoring for connective tissue disease should be considered in such patients when symptoms arise. ■ For patients manifesting acute respiratory worsening, the possibility of acute exacerbation of IPF should be entertained, and prompt evaluation for alternative etiologies of acute worsening such as pulmonary embolus, pneumothorax, respiratory infection, or aspiration should be undertaken. ■ Monitoring for complications associated with pharmacologic therapy will need to be tailored to the known side-effect profiles of the specific treatment regimen. An American Thoracic Society Pocket Publication 23 

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ATS Pocket Guide 2013

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