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.

Exclusion Criteria:

- Patients and/or caregivers with cognitive or other difficulties that would preclude
questionnaire completion.

- Inability to speak or understand English.

- Patients considered to be dying or with an expected survival of less than 2 months.