This patient with underlying chronic obstructive pulmonary disease (COPD) has the following signs suggesting significant pulmonary hypertension:
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.
This patient has "proportional" pulmonary hypertension (mean pulmonary artery pressure 29 mm Hg) and is not a candidate for additional treatment. The mainstays of treatment for patients with mild-to-moderate PH associated with COPD remain long-term oxygen therapy, smoking cessation, inhaled bronchodilators, and inhaled corticosteroids.