Palliation of Dyspnea in Advanced Chronic Obstructive Pulmonary Disease (COPD)

Inclusion Criteria

• •We define advanced COPD as including those with severe COPD by CTS criteria (i.e., severe shortness of breath resulting in the patient being too breathless to leave the house, or breathlessness after dressing/undressing (i.e., Medical Research Council (MRC) score of 5), or the presence of chronic respiratory failure (PaCO2\>45) or clinical signs of right heart failure).
• •We will also include patients who are short of breath and stop walking after about 100 meters or a few minutes on the level (MRC score 4) with at least one the following:
• •* BMI \< 21;
• •* post-bronchodilator FEV1 \< 30% predicted;
• •* one or more hospital admissions for acute exacerbation of COPD in the previous year.
• •MRC 4 patients will be recruited only if their baseline Chronic Respiratory Questionnaire - dyspnea domain (CRQ-D) score is \< 5, an entry criterion used in a Canadian RCT involving patients with advanced lung disease.