Cor Pulmonale — RACP Adult Medicine MCQ

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ModerateRespiratoryCor PulmonaleRACP Adult Medicine

A 70-year-old man with COPD and cor pulmonale develops peripheral oedema. His ABG shows PaO₂ 50 mmHg and PaCO₂ 60 mmHg. What is the most effective long-term treatment to improve survival in cor pulmonale secondary to COPD?

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Correct answer: D — Bosentan

Long-term oxygen therapy (LTOT) for ≥15 hours/day is the ONLY intervention proven to improve survival in COPD with chronic hypoxaemia and cor pulmonale (MRC and NOTT trials). It reduces pulmonary vascular resistance, improves right heart function, and reduces polycythaemia. Diuretics (frusemide) manage fluid overload symptomatically. Pulmonary vasodilators (sildenafil, bosentan) are NOT recommended for COPD-associated pulmonary hypertension.

Reference: Lung Foundation Australia/TSANZ – 2025 – COPD-X Plan; eTG – 2025 – Respiratory