In COPD with pulmonary hypertension, what is the SINGLE most important therapy to reduce morbidity?

• A. CCB
• B. Albuterol
• C. O2 supplementation
• D. Ipratropium bromide/albuterol

Answer: (C)

Chronic hypoxemia drives pulmonary vasoconstriction and progression of pulmonary hypertension in COPD, and it also contributes to complications like polycythemia and right-heart strain. Supplying supplemental oxygen corrects the low oxygen levels, which reduces hypoxic pulmonary vasoconstriction, lowers pulmonary artery pressures, and improves survival and quality of life. Long-term oxygen therapy has a proven mortality and morbidity benefit in hypoxemic COPD, making it the most impactful intervention for reducing morbidity in this scenario. Bronchodilators and anticholinergics help symptoms but do not alter disease progression or mortality in COPD with pulmonary hypertension, and calcium channel blockers are not standard for this condition.