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Managing Pulmonary Hypertension and COPD

Updated on November 15, 2021
Medically reviewed by
Steven C. Pugliese, M.D.
Article written by
Jessica Kirchner, RN

People who have pulmonary hypertension (PH) and chronic obstructive pulmonary disease (COPD), both chronic lung diseases, often experience shortness of breath doing daily activities. Living with both conditions can make doing simple things feel like strenuous exercise. Managing both conditions is a reality for over 2,100 myPHteam members.

What Is Pulmonary Hypertension?

Pulmonary hypertension is a condition where the blood pressure in the blood vessels around the heart and lungs, called the pulmonary arteries, rises to abnormally high levels. Like high blood pressure (hypertension), having PH can cause serious complications. PH may also make some COPD symptoms, such as shortness of breath, worse or more frequent.

Both conditions contribute to restricted airflow and decreased pulmonary function, which makes it harder to breathe. Research shows that having PH in addition to COPD can decrease survival rates and worsen other health outcomes, like hospitalizations.

Causes of Pulmonary Hypertension

Some cases of PH are caused by COPD, a type of chronic obstructive lung disease. PH is organized into several categories by the World Health Organization. These categories reflect the underlying cause of PH. For example, PH caused by COPD or other chronic lung diseases is categorized in Group 3.

Risk Factors

Having a chronic lung disease like COPD is a risk factor for developing PH. Both PH and COPD have genetic or family history risk factors. Frequent inhalation of toxins like cigarette smoke, dust, and air pollution is also a risk factor for both conditions.

Shared Symptoms of PH and COPD

Oxygenation, or your heart and lungs’ ability to distribute oxygen throughout your body, is impaired with both conditions. Because both lung diseases affect oxygenation, they have similar symptoms.

If you live with both PH and COPD, you may experience some of these common shared symptoms:

  • Shortness of breath, or dyspnea
  • Dizziness
  • Increased tiredness, or fatigue

When the lungs get damaged, like in COPD or other lung diseases, the heart must work harder to pump blood throughout the body, including the lungs. This is why activity or exercise may worsen PH and COPD symptoms like shortness of breath — when you are active, your body needs more oxygen. As a result, people with PH and COPD often have lower amounts of oxygen in their blood (hypoxemia). Being hypoxic may cause you to feel tired, fatigued, or lightheaded. Untreated hypoxia can be extremely dangerous.

People with COPD commonly experience heart problems as well. They can have weakening and improper functioning of the left-sided heart muscles and chambers due to a variety of factors, including low oxygen, inflammation, and co-existing medical problems. This is called left-sided ventricular dysfunction. This damage and incorrect functioning of the heart may also be worsened when a person has PH in addition to COPD, as both the left and right sides of the heart can be affected. Individuals with COPD and PH are therefore prone to poor functioning of the heart, which can result in a variety of symptoms like shortness of breath, cough, swelling, fatigue, irregular heart beat, and more.

Having these shared symptoms can make it difficult to get an accurate PH diagnosis. The exact prevalence of PH with COPD is unknown, but research suggests that it is common for those with PH to also have a diagnosis of COPD.

How Pulmonary Hypertension Is Diagnosed

Because of the shared symptoms of PH and COPD, getting a diagnosis of PH can be challenging. In the early stages of PH, you might not be aware of any changes in your symptoms.

An official diagnosis of pulmonary hypertension can only be made through specific diagnostic tests. Some tests used to detect PH are different from the tests used to diagnose COPD. Other tests, like pulmonary function tests, can provide valuable information about the status of both your COPD and PH.

The gold standard for accurately diagnosing PH is a procedure called right heart catheterization (RHC). Because this test is invasive and can be risky, it is not performed routinely for people with COPD. Your doctor may choose to have an ultrasound of your heart, called an echocardiogram, performed to screen for PH before deciding on a RHC. However, if your doctor suspects you might have PH, they will determine if you are healthy enough to have the procedure.

Treating Pulmonary Hypertension and COPD

PH caused by COPD may be more challenging to manage. Because PH is commonly caused by COPD, a primary goal of treatment is to keep COPD under control. In addition to preventing exacerbations, managing symptoms like shortness of breath can improve your quality of life.

Treatment options for PH and COPD may include:

  • Long-term oxygen therapy to improve oxygenation and prevent hypoxia
  • Exercise rehabilitation to improve exercise capacity
  • Prescription medications that are appropriate for your specific circumstances

Treatment of PH and COPD is holistic and geared toward improving quality of life by improving pulmonary function and exercise capacity. Improving your lung function through PH and COPD treatments may bring you closer to getting back to the things you enjoy.

There is no known cure for PH or COPD. However, treatment of PH with methods like long-term oxygen therapy may make the conditions more manageable. One myPHteam member shared, “With portable oxygen, I can still do the things I need and want to do.”

Surgical Treatment of PH and COPD

For those with severe COPD and PH, more drastic treatment options might be considered. For example, some severe PH and COPD treatments involve surgery, such as lung transplantation or lung volume reduction surgery.

A lung transplant removes the damaged lung from your body and replaces it with a healthy lung received from a donor.

Lung volume reduction surgery only removes part of the lung, often the most damaged part. This helps to improve pulmonary function.

Future Treatments

More research is needed to discover optimal treatment options for PH that is caused by COPD. But members living with PH and COPD should remain hopeful. Prescription drug trials are underway to find a new drug that will specifically treat the two conditions effectively and safely.

Living With PH and COPD

Members of myPHteam have shared how having PH along with COPD can significantly impact their quality of life. Things you enjoy, like walking or exercising, may become more difficult. It may feel harder to breathe.

Members described how it feels to live with PH and COPD:

  • “There is severe shortness of breath associated with just about any activity.”
  • “Shortness of breath is, unfortunately, one of the most dreaded symptoms of PH. It’s scary.”
  • “I have pain in my chest. It feels more like pressure sometimes. These are rough issues to deal with.”

PH and COPD Management at Home

Managing PH and COPD may seem complex, but by focusing on your health and communicating with your health care providers, you can take charge of your conditions. Staying involved in your care can help you to feel in control and may improve your outlook. Research suggests that your health and wellness may improve as you become more active and engaged with your care.

When talking with your doctor, do not be afraid to ask questions. Understanding how COPD and PH can affect your health and daily life is an essential step to managing these conditions at home. The more you know, the more comfortable and confident you may feel about your ability to care for yourself. Successfully managing PH and COPD symptoms may help prevent exacerbations or flare-ups. Following your care plan closely and keeping in touch with your doctor can help you stay on track.

Members of myPHteam shared their tips for managing PH and COPD:

  • “Along with talking with others in support groups, I went to a therapist. It helped me. I learned to appreciate what I can do and have adjusted my lifestyle a bit.”
  • “Inhalers and nebulizers are used often with both diseases. I have found both to be of help, especially with COPD.”
  • “One of the most recommended tips to help the shortness of breath is ‘Pursed-Lip Breathing.’”

Another member encouraged those struggling with PH and COPD: “Remember that you are not alone, ever.”

Other members shared similar benefits of being part of myPHteam:

  • “I have PH and COPD and have learned a lot about my diseases here. I feel it is easier to cope with now.”
  • “I have PH and COPD. I have learned so much about my diseases by reading articles or asking questions here. It has helped me cope.”

Talk With Others Who Understand

On myPHteam, the social network for people with pulmonary hypertension and their loved ones, more than 39,000 members come together to ask questions, give advice, and share their stories with others who understand life with pulmonary hypertension.

Are you living with pulmonary hypertension and COPD? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Pulmonary Hypertension — American Lung Association
  2. Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease — European Respiratory Journal
  3. Updated Perspectives on Pulmonary Hypertension in COPD — International Journal of Chronic Obstructive Pulmonary Disease
  4. Activity-Related Dyspnea in Chronic Obstructive Pulmonary Disease: Physical and Psychological Consequences, Unmet Needs, and Future Directions — International Journal of Chronic Obstructive Pulmonary Disease
  5. Hypoxemia in Patients With COPD: Cause, Effects, and Disease Progression — International Journal of Chronic Obstructive Pulmonary Disease
  6. Left Ventricular Diastolic Dysfunction in Patients With Chronic Obstructive Pulmonary Disease (COPD), Prevalence and Association With Disease Severity: Using Tissue Doppler Study — Egyptian Journal of Chest Diseases and Tuberculosis
  7. Pulmonary Hypertension in COPD — Respiratory Care
  8. About Pulmonary Hypertension — Pulmonary Hypertension Association
  9. Pulmonary Hypertension: Symptoms and Causes — Mayo Clinic
  10. Risk Factors — Pulmonary Hypertension Association
  11. COPD Causes and Risk Factors — American Lung Association
  12. Pulmonary Hypertension in COPD — European Respiratory Journal
  13. PH With COPD: Is Sildenafil an Effective Treatment Option? — Pulmonary Hypertension Association
  14. Long-Term Effect of Vasodilator Therapy in Pulmonary Hypertension Due to COPD: A Retrospective Analysis — Lung
  15. Iloprost — MedlinePlus
  16. Lung Volume Reduction Surgery — American Lung Association
  17. A Phase 3 Adaptive Study To Evaluate the Safety and Efficacy of Inhaled Treprostinil in Participants With Pulmonary Hypertension (PH) Due to Chronic Obstructive Pulmonary Disease (COPD) (PERFECT) — ClinicalTrials.gov
  18. Patient Engagement and Self-Management in Pulmonary Arterial Hypertension — European Respiratory Review
  19. Pursed-Lip Breathing — StatPearls
Steven C. Pugliese, M.D. is affiliated with the Hospital of the University of Pennsylvania in Philadelphia, serving as the director of the pulmonary embolism response team, co-director of the comprehensive pulmonary embolism program, and an assistant professor of clinical medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jessica Kirchner, RN is the director of nursing practice for the Ohio Nurses Association. Learn more about her here.

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