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Studies examining pulmonary vasodilator therapy in COPD-PH have shown mixed results, likely due to the heterogenous nature of PH in COPD. We aimed to assess whether pulmonary vasodilator therapy is associated with improvement in transplant-free survival in patients with COPD and severe PH. A retrospective study of patients with COPD and PH defined as a mean pulmonary artery pressure (mPAP) greater than 20 mmHg was conducted. Right heart catheterization data, pulmonary function testing, pulmonary vasodilator therapy, and outcome data including death and transplant were collected. Transplant-free survival analysis was performed via Kaplan-Meier and multivariable cox regression. PH therapy was significantly and independently associated with reduced risk of death or transplant in patients with PVR\u2009&gt;\u20095 WU (HR 0.29, 95% CI 0.10\u20130.81,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) and patients with PVR\u2009&gt;\u20095 WU and mPAP\u2009&gt;\u200940 mmHg (HR 0.11, 95% CI, 0.17\u20130.74,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02), even when accounting for other markers of disease severity (GOLD stage, DLCO, 6MWD, O2 requirement, BNP) and COPD treatment (triple inhaled therapy). Pulmonary vasodilator therapy had the most significant association with reduced risk of death or transplant among those with both PVR\u2009&gt;\u20095 WU and mPAP\u2009&gt;\u200940 mmHg, suggesting that patients with a significant pulmonary vascular phenotype may benefit from these therapies.\n                  <\/jats:p>","DOI":"10.1186\/s12890-026-04203-4","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T01:24:14Z","timestamp":1772069054000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary vasodilator therapy is associated with improved survival in COPD-PH with pulmonary vascular predominance"],"prefix":"10.1186","volume":"26","author":[{"given":"Taylor","family":"Caton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Pescatore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Naranjo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shameek","family":"Gayen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"issue":"1","key":"4203_CR1","doi-asserted-by":"publisher","first-page":"1801914","DOI":"10.1183\/13993003.01914-2018","volume":"53","author":"SD Nathan","year":"2019","unstructured":"Nathan SD, Barbera JA, Gaine SP, Harari S, Martinez FJ, Olschewski H, Olsson KM, Peacock AJ, Pepke-Zaba J, Provencher S, Weissmann N, Seeger W. 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