Is There a Place for Vasodilators in Stable COPD?

The advent of pulmonary hypertension (PH) represents an ominous development in patients with chronic obstructive pulmonary disease (COPD) affecting approximately 50% of patients over 50 years of age and is associated with an adverse prognosis (1). Right ventricular hypertrophy in COPD patients, referred to as cor pulmonale, is present in 70% of patients with a forced expiratory flow in one second (FEV1) lower than 600 mL (2). Several studies have shown that PH or peripheral edema in COPD patients is correlated with decreased survival (3,4). Indeed survival rates of COPD patients with a moderate to high pulmonary vascular resistance are comparable to that of inoperable lung cancer (1).