This module focuses on sustaining effective PAH management over time by integrating ongoing risk assessment with treatment persistence, tolerability, and evolving patient needs. It examines when continued therapy, escalation, transition, or carefully selected de-escalation may be appropriate, while emphasizing that failure to achieve or maintain low-risk status should prompt reassessment. The module also addresses adverse-effect mitigation, treatment burden, adherence, and the importance of avoiding abrupt discontinuation of PAH therapies, reinforcing a patient-centered approach that continually aligns treatment intensity with disease control and the patient's capacity to sustain therapy.

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This module explores how risk status, clinical trajectory, right ventricular function, hemodynamics, and patient-specific factors inform the selection and escalation of PAH therapy. It reviews therapies targeting the endothelin, nitric oxide, prostacyclin, and activin signaling pathways and considers how combination therapy and route of administration can be individualized according to disease severity and treatment goals. Particular emphasis is placed on balancing therapeutic efficacy with treatment burden, lifestyle, adherence, support systems, and the patient's ability to manage therapy through shared decision-making.

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This module examines structured risk assessment as the foundation for goal-directed management of pulmonary arterial hypertension (PAH), emphasizing that clinical stability is not synonymous with low-risk status. It reviews validated risk-stratification approaches and the integration of functional capacity, biomarkers, imaging, and hemodynamics to assess prognosis and treatment response. The module emphasizes routine reassessment and timely treatment modification when patients fail to achieve or maintain low-risk status, while also incorporating treatment burden and patient preferences into shared decision-making.

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This module addresses the evolving management of patients who have achieved sustained clinical improvement but may experience treatment fatigue, adverse effects, or substantial treatment burden. It explores when therapy transition or de-escalation may be considered, emphasizing careful patient selection based on sustained clinical improvement, favorable risk status and hemodynamics, patient goals, and the ability to provide close follow-up. Because clinical worsening can occur during or after treatment transitions, the module reinforces ongoing reassessment of risk, functional capacity, biomarkers, cardiac findings, and treatment sustainability as essential components of long-term PAH management.

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This module focuses on translating PAH treatment strategy into an individualized, sustainable regimen by considering route of administration, titration, tolerability, and treatment burden. It examines the practical differences among oral, inhaled, subcutaneous, and intravenous therapies and how disease severity, treatment response, adverse effects, patient preferences, and capacity for self-management influence therapeutic choices. The module also emphasizes proactive adverse-event management, individualized titration, frequent reassessment, patient education, and multidisciplinary support to promote treatment persistence while continuing to pursue appropriate risk-based treatment goals.

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This module establishes risk assessment as the foundation of treatment decision-making in pulmonary arterial hypertension (PAH). It reviews multidimensional risk stratification, treatment goals, and the use of clinical, functional, biomarker, imaging, and hemodynamic findings to guide initial therapy and subsequent reassessment. Through a high-risk PAH case, the module illustrates how treatment intensity and sequencing should reflect disease severity and clinical trajectory, with timely escalation when low-risk status is not achieved or maintained.

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Idiopathic pulmonary fibrosis (IPF) presents ongoing challenges across the patient journey, from timely diagnosis to long-term disease management. Nonspecific symptoms often delays appropriate imaging and referral, while issues related to antifibrotic tolerability and treatment discontinuation may further complicate care. Clinicians must also consider changes in physiologic measures, including DLco, alongside emerging understanding of pulmonary vascular involvement and evolving therapeutic approaches.

In this podcast, Dr. Kevin Flaherty shares expert perspectives and case-based insights on recognizing IPF earlier, optimizing antifibrotic therapy, proactively addressing adverse events, and interpreting key diagnostic and prognostic indicators. Listen in to explore strategies that can help inform timely diagnosis, individualized treatment decisions, and ongoing care for patients living with IPF.

Launch/Release Date: September 14, 2026

Activity Expiration Date: August 31, 2027

FACULTY

Kevin Flaherty, MD

Director, Interstitial Lung Disease Program

University of Michigan Health

This podcast provides accredited continuing education credits. To receive your credit, please read the accreditation information provided in this link prior to listening to this podcast.