The effect of atorvastatin combined with azithromycin on lung function and right heart function in COPD patients with concomitant pulmonary hypertension

Background Chronic obstructive pulmonary disease (COPD) often coexists with pulmonary hypertension (PH), leading to exacerbated morbidity and mortality. Conventional treatments focus on bronchodilation, anti-inflammatory agents, and vasodilators, emphasizing the need for novel interventions. Atorvastatin and azithromycin have pleiotropic properties that may benefit COPD with concomitant PH. However, the combined impact of these medications on lung and right heart function in this patient population remains underexplored. Methods A retrospective cohort study involving 229 stable COPD patients with concomitant PH assessed the effects of atorvastatin combined with azithromycin. Patients were divided into atorvastatin monotherapy and atorvastatin plus azithromycin combination therapy groups and underwent a 6-month treatment period. Blood testing, pulmonary function testing, and echocardiographic assessment of right heart function were conducted before and after treatment. Results The combination therapy group exhibited significant improvements in blood gas indicators (mean PaO 2 increase: 1.22 kPa, 95% CI: 0.82–1.62 kPa, p < 0.001), lung function (mean FEV1 increase: 0.18 L, 95% CI: 0.08–0.28 L, p < 0.001), right heart function (mean PAPs reduction: 8.0 mmHg, 95% CI: 7.0–9.0 mmHg, p < 0.001), respiratory distress, and daily living ability compared to the monotherapy group. Positive correlations were observed between improvements in pulmonary function and daily living ability. The combination therapy resulted in a significantly higher total effective rate (84.48% vs. 72.73%, p = 0.042) compared to the monotherapy group. Conclusion This retrospective study suggests potential associations between combination therapy with atorvastatin and azithromycin and improvements in functional outcomes in COPD patients with concomitant PH. These findings warrant prospective validation in randomized controlled trials.