title: Monitoring of nonsteroidal immunosuppressive drugs in patients with lung disease and lung transplant recipients: American College of Chest Physicians evidence-based clinical practice guidelines.
abstract: OBJECTIVE
  Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and inflammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents.
  
  
  METHODS
  Committee members developed and refined a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline.
  
  
  CONCLUSIONS
  It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease.
authors.affiliation: University of Cincinnati, Cincinnati, OH. Electronic address: bob.Baughman@uc.edu.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Baughman
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Meyer
authors.affiliation: University of Central Florida, Orlando, FL.
authors.forename: Ian
authors.initials: I
authors.lastname: Nathanson
authors.affiliation: University of Texas Health Sciences, San Antonio, TX.
authors.forename: Luis
authors.initials: L
authors.lastname: Angel
authors.affiliation: University of Chicago Hospitals, Chicago, IL.
authors.forename: Sangeeta M
authors.initials: SM
authors.lastname: Bhorade
authors.affiliation: University of Michigan Health Systems, Ann Arbor, MI.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Cleveland Clinic, Cleveland, OH.
authors.forename: Daniel
authors.initials: D
authors.lastname: Culver
authors.affiliation: American College of Chest Physicians, Northbrook, IL.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Harrod
authors.affiliation: University of Wisconsin School of Pharmacy, Madison, WI.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Hayney
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Kristen B
authors.initials: KB
authors.lastname: Highland
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Limper
authors.affiliation: Drexel University College of Medicine, Philadelphia, PA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Patrick
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Charlie
authors.initials: C
authors.lastname: Strange
authors.affiliation: University of Minnesota, Minneapolis, MN.
authors.forename: Timothy
authors.initials: T
authors.lastname: Whelan
mesh_terms: D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008171:Lung Diseases / Q000188:drug therapy* / Q000276:immunology; D016040:Lung Transplantation / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents