A 70-year-old man with severe COPD (FEV1 28% predicted) on long-term oxygen therapy (>15 hours/day) and optimal inhaled therapy develops worsening peripheral edema and raised JVP. Echocardiography shows dilated right ventricle with estimated pulmonary artery systolic pressure of 60 mmHg. Which therapy has been shown to improve survival in this patient?
- A Sildenafil
- B Furosemide
- C Long-term oxygen therapy ✓
- D Bosentan
Correct answer: C. Long-term oxygen therapy
Explanation
This patient has cor pulmonale secondary to COPD with pulmonary hypertension. Long-term oxygen therapy (>15 hours/day) is the only intervention proven to improve survival in hypoxemic COPD patients, as demonstrated by the NOTT and MRC trials. Pulmonary vasodilators (sildenafil, bosentan) have not shown mortality benefit in COPD-related pulmonary hypertension and may worsen gas exchange. Diuretics manage edema but do not improve survival.
Reference: GOLD Report Global Strategy for COPD, 2024 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.