What treatment should a patient with COPD and pulmonary hypertension, who is unresponsive to typical medications, likely require?

In cases of chronic obstructive pulmonary disease (COPD) complicated by pulmonary hypertension, especially when patients respond poorly to standard treatments, the use of epoprostenol is often considered an effective approach. Epoprostenol is a prostacyclin analog that acts as a potent vasodilator. It primarily works by dilating the pulmonary and systemic arterial vascular beds, which can significantly decrease pulmonary artery pressure and improve symptoms associated with pulmonary hypertension.

This treatment can also improve exercise capacity and functional status in patients with pulmonary hypertension resulting from COPD. Moreover, epoprostenol has beneficial effects on the right ventricle, which is often burdened due to increased pressure in the pulmonary circulation. In resistant cases of pulmonary hypertension in COPD patients, the use of epoprostenol is often deemed necessary despite the challenges in its delivery and side effects.

Oxygen therapy, sildenafil, and diuretics are important in managing COPD and its complications but do not specifically address the severe pulmonary hypertension that may not respond to conventional treatments. Oxygen therapy primarily aims to improve hypoxemia, sildenafil can help but may not have a strong enough effect in severe cases, and diuretics are utilized to manage fluid overload but do not directly affect pulmonary vascular resistance.