Treatment guidelines for pulmonary arterial hypertension (PAH) have recommended combination therapy since 2015. This study aimed to understand current combination therapy prescribing in the real-world setting in 4 Latin American countries. The point-in-time Adelphi PAH Disease Specific Programme 2021, surveyed physicians and adult patients with PAH across Argentina, Brazil, Colombia, and Mexico. Physicians reported treatment history for 4-6 patients with a physician confirmed diagnosis of PAH. Results were stratified by World Health Organisation functional classification (FC I - IV), and by country and presented as a mean (SD) or proportions. Data from 766 treated PAH patients were analysed. Mean patient age was 53.7 years (17.5) and 70% were female. Combination therapy using PAH-specific (endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, soluble guanylate cyclase stimulators or prostacyclin pathway agents) were prescribed to 49% of patients. However, the proportion of patients prescribed combination therapy varied across countries (Argentina, 79%; Brazil 30%; Colombia 70%; Mexico, 20%). Initial combination therapy was prescribed in 38% of patients and add-on combination therapy was prescribed in 69% of patients. Combination therapy prescribing was similar across FC status (FC I 44%; FC II, 50%; FC III, 49%; FC IV 67%). Despite evidence for combination therapy and guideline recommendations, usage of PAH-specific combination therapy varied greatly across Latin American countries, ranging from 20 – 79% of patients based on current prescription records. The reasons and clinical impact of this difference need to be further understood.