Breathe Easier With Tadalafil Therapy for Dyspnea in COPD-PH

Inclusion criteria

• ✓. Outpatients with COPD, defined as airflow limitation with post-bronchodilator obstruction on baseline visit spirometry, identified by FEV1/FVC \< 70% or \< the lower limit of normal (5th percentile of a normal population based on Global Lung Function Initiative reference equations), OR any emphysema on chest CT noted in a clinical radiology report confirmed by study investigator review.
• ✓. Eligible subjects must have PH documented as follows:
• ✓. Main Pulmonary Artery/Ascending Aorta (PA/A) diameter \> 0.90 on clinically available CT scans within 12 months OR
• ✓. Main Pulmonary Artery diameter \> 30.8mm on clinically available CT scans within 12 months OR
• ✓. outpatient echocardiography done within 6 months of enrollment demonstrating PA sys \> 34 mmHg OR
• ✓. Mean Pulmonary Artery Pressure \> 20 on Right Heart Catheterization done within 6 months of enrollment and when Veteran is clinically stable.
• ✓. Eligible subjects must be dyspneic, as quantitated by a score of at least 20 on the baseline UCSD Shortness of Breath Questionnaire, assessed at the time of the baseline visit.
• ✓. Treatment with at least one long-acting bronchodilator for at least 4 weeks, assessed at the time of the baseline visit by chart review and patient interview.