COPD patients have proportional pulmonary hypertension

COPD patients can have mild to moderate pulmonary hypertension. When they have severe PH (mPAP > 35-40 mmHg), concurrent PAH workup should be initiated.

Drugs approved for pulmonary arterial hypertension are not recommended for patients who have pulmonary hypertension secondary to COPD.

Source

This patient with underlying chronic obstructive pulmonary disease (COPD) has the following signs suggesting significant pulmonary hypertension:

  • Hypoxemia
  • Peripheral edema
  • Murmur of tricuspid insufficiency
  • Prominent pulmonic component of the second heart sound

Many patients with COPD have associated pulmonary hypertension (PH).  Right heart catheterization is definitive for diagnosis of PH, although the diagnosis can be confirmed with echocardiography in most patients.

PH in COPD is usually mild-to-moderate in severity.  However, patients with COPD may occasionally display more severe PH (mean pulmonary artery pressure >35-40 mm Hg) that is excessive for the (mild) degree of underlying COPD.  These patients will have increased dyspnea, and it is speculated that this may represent concurrent idiopathic pulmonary arterial hypertension.  Pulmonary vasoactive agents, including sildenafil, bosentan, and iloprost, have been considered for use in these patients, but studies to date have been limited.