FREQUENCY OF PULMONARY HYPERTENSION IN COPD PRESENTING TO TERTIARY CARE HOSPITAL

Abstract

Background; Chronic obstructive pulmonary disease (COPD) is a major global health concern and is frequently complicated by pulmonary hypertension (PH), which significantly worsens morbidity and mortality. Despite its clinical importance, local data on the frequency of PH among COPD patients in Pakistan remains limited. Objective; To determine the frequency of pulmonary hypertension among patients with chronic obstructive pulmonary disease presenting to a tertiary care hospital. Methods: This cross-sectional study was conducted at Ayub Teaching Hospital, Abbottabad, over a period of six months from 1st September 2024 to 28th February 2025. A total of 134 patients aged 18–80 years with spirometry-confirmed COPD were enrolled using non-probability consecutive sampling. Patients with other causes of pulmonary hypertension were excluded. Demographic and clinical data were recorded, and pulmonary hypertension was assessed using transthoracic echocardiography, defined as pulmonary artery systolic pressure (PASP) ≥25 mmHg. Data were analyzed using SPSS version 21, and associations were assessed using chi-square test, with p ≤0.05 considered statistically significant. Results: The mean age of participants was 58.4 ± 10.6 years, with 53.7% in the 41–60 years age group. Males constituted 68.7% of the study population. Regarding smoking status, 44.8% were current smokers, 29.9% former smokers, and 25.4% never smokers. The majority of patients had moderate COPD (46.3%), followed by severe (29.9%), mild (14.9%), and very severe disease (9.0%).Pulmonary hypertension was present in 43.3% (n=58) of patients. Among these, mild PH was observed in 51.7%, moderate in 31.0%, and severe in 17.3%, with a mean PASP of 33.2 ± 8.5 mmHg. Dyspnea (89.6%), chronic cough (80.6%), and sputum production (70.9%) were the most common symptoms.A statistically significant association of PH was found with age (p=0.03) and smoking status (p=0.01), while gender was not significantly associated (p=0.42). PH was also significantly associated with comorbidities, including diabetes mellitus (p=0.002), cardiovascular disease (p=0.01), presence of both conditions (p=0.04), and absence of comorbidities (p=0.001). Echocardiographic findings included right ventricular hypertrophy in 29.9%, right atrial enlargement in 26.1%, and tricuspid regurgitation in 20.9% of patients. Conclusion: Pulmonary hypertension is a common complication among COPD patients, with a frequency of 43.3% in this study. It is more frequently associated with advancing age, smoking, and comorbid conditions. Early screening using echocardiography in COPD patients may facilitate timely diagnosis and improve clinical outcomes, particularly in resource-limited settings.