Pulmonary disease monitoring therapy

A beta-blocker may be used in the treatment of primary open-angle glaucoma, but these drugs are contraindicated for use in persons with chronic obstructive pulmonary disease and heart block (see Chapter 10). A careful history should be taken before initiating therapy to avoid potentially fatal ramifications. It is advisable to monitor patients who are taking beta-blockers (e.g., pulse, blood pressure) and to inquire about side effects at periodic follow-up examinations. 

A common reason for diuretic use is for reduction of peripheral or pulmonary edema that has accumulated as a result of cardiac, renal, or vascular diseases that reduce blood delivery to the kidney. This reduction is sensed as insufficient effective arterial blood volume and leads to salt and water retention and edema formation. Judicious use of diuretics can mobilize this interstitial edema without significant reductions in plasma volume. However, excessive diuretic therapy may lead to further compromise of the effective arterial blood volume with reduction in perfusion of vital organs. Therefore, the use of diuretics to mobilize edema requires careful monitoring of the patient s hemodynamic status and an understanding of the pathophysiology of the underlying illness. 

Although imaging has a limited role before HSC transplantation, it is important after transplantation when it may support the clinical diagnosis of a variety of complications. It may also be used to monitor the effect of therapy and to detect recurrence of the underlying disease if the transplant is unsuccessful (Evans et al. 2003). The most useful imaging modalities available for the evaluation of the patient with known or suspected post-transplant pulmonary complications are chest radiography and computed tomography (Wah et al. 2003). 

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