A meta-analysis of 11 randomized controlled trials with 865 patients evaluated the efficacy of fasudil as adjunctive therapy in pulmonary arterial hypertension (PAH) associated with chronic obstructive pulmonary disease (COPD). Fasudil significantly increased the overall effective treatment rate (hazard ratio 1.18, 95% CI 1.05–1.31, p=0.004) and reduced pulmonary artery systolic pressure (mean difference -9.42 mmHg, 95% CI -10.73 to -8.12, p<0.001). Chronic treatment (≥2 weeks) improved blood oxygen saturation (MD 3.56%, 95% CI 1.73–5.40), whereas a single dose had minimal effect. Arterial oxygen pressure increased slightly (MD 2.19 mmHg, 95% CI 0.84–3.54, p=0.002). Distance in the 6-minute walk test improved by 51.96 m (95% CI 36.84–67.08, p<0.001), exceeding the minimal clinically significant difference. The studies were of moderate methodological quality, limited to a Chinese setting and short follow-up (maximum 4 weeks).