Prevalence of Pulmonary Hypertension and Its Severity in Patients With Chronic Obstructive Pulmonary Disease

Abstract

Background
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death and disability worldwide. Pulmonary Hypertension (PH) secondary to COPD significantly contributes to morbidity and mortality. Early identification of this comorbidity may improve prognosis. This study aimed to evaluate the prevalence of PH in COPD patients and assess the association between PH severity and COPD severity using transthoracic echocardiography.
Methods
An observational cross-sectional study was conducted at Bir, Hospital, Kathmandu over six months from August 2019 to January 2020. Sixty-seven patients with spirometry-confirmed COPD were enrolled. PH was assessed using two-dimensional trans-thoracic echocardiography. Doppler echocardiography, defined as systolic pulmonary arterial pressure (sPAP) ≥35 mmHg. COPD severity was classified according to GOLD guidelines.
Results
The mean age was 68.5±6.7 years; 56.7% were male. The prevalence of PH was 86.6% (58/67 patients). Among these, mild, moderate, and severe PH was observed in 25.4%, 17.9%, and 43.3% of patients, respectively. The frequency of PH increased with COPD severity: 25% in GOLD Grade 1, 80% in Grade 2, 93.1% in Grade 3, and 100% in Grade 4. The association between COPD severity and PH severity was statistically significant (p<0.001).
Conclusions
PH was highly prevalent in this cohort of COPD patients, with both frequency and severity increasing with worsening airflow obstruction. Echocardiography represents a useful non-invasive tool for PH detection in COPD, particularly in patients with advanced disease. However, findings should be interpreted cautiously given study limitations.