PDE5A and pulmonary hypertension: Finally, there is definitely a lack of evidence of a long-term clinical beneficial effect of PDE5 inhibitors in COPD patients (Seeger et al., 2013), even if a recently published study demonstrated that treatment with sildenafil is able to reduce pulmonary vascular resistance and improve the BODE index (a multidimensional grading system that predict mortality in COPD) and quality of life, without a significant effect on gas exchange, in a cohort of patients with severe pulmonary hypertension and COPD (Vitulo et al., 2017).