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COPD-associated pulmonary hypertension — SCE Respiratory MCQ

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HardCOPDCOPD-associated pulmonary hypertensionSCE Respiratory

A 76-year-old woman with COPD has ankle swelling and exertional syncope. Echocardiography estimates pulmonary artery systolic pressure at 58 mmHg with right ventricular dilatation; left ventricular systolic function is preserved. ABG on air shows PaO2 7.0 kPa and PaCO2 6.1 kPa, and CT pulmonary angiography shows no acute embolus. She has not had a formal sleep assessment. What is the most appropriate management?

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Correct answer: C — Assess for chronic hypoxaemia and refer to a pulmonary hypertension or oxygen service

Pulmonary hypertension in COPD is often driven by chronic hypoxaemia and requires structured assessment, including oxygen need and consideration of specialist referral when disproportionate. Sildenafil is not started empirically in COPD-related pulmonary hypertension without specialist evaluation. Right-heart strain should prompt a search for contributors such as hypoxaemia, sleep-disordered breathing and chronic thromboembolic disease.

Reference: NICE NG115 COPD; ESC/ERS Pulmonary Hypertension Guideline 2022