Breathlessness services and specialist palliative care for advanced chronic obstructive pulmonary disease: a narrative review

Chronic obstructive pulmonary disease (COPD) is a progressive condition associated with high distress, functional decline, and reduced quality of life. As the disease advances, palliative care becomes increasingly pertinent to address not only physical symptoms, such as breathlessness, but also the emotional and social challenges experienced by individuals with COPD and their caregivers. Emerging evidence supports the benefits of earlier palliative care integration across the disease trajectory, and there are various models of palliative care for people with COPD. This narrative review synthesizes current evidence on supportive breathlessness clinics and specialist palliative care services for individuals living with COPD. The findings highlight that while supportive services significantly enhance patients’ coping, confidence, and psychological well-being, their availability and integration into routine care remain limited. Interventions that include home visits, personalized approaches, and peer interaction are particularly valued by people with COPD and are associated with reduced distress and improved self-management. Moreover, interpersonal connection and regular empathetic contact with healthcare professionals emerged as central therapeutic mechanisms. Despite these promising outcomes, many studies face methodological limitations, including small sample sizes, a lack of condition-specific focus, and challenges in evaluating psychosocial impacts. Specialist palliative care remains underutilized in COPD populations, and access is often delayed or absent compared to people with malignant diseases. Integrating respiratory and palliative expertise in flexible, community-based services offers a promising direction to improve quality of life and end-of-life care for this underserved population. To ensure equitable care, future efforts should prioritize timely access to supportive care, greater integration with respiratory services, and the inclusion of people with COPD in palliative care planning and research. Future research should focus on inclusive and patient-centered approaches which explore how to sustainably deliver patient-centered and multidisciplinary support across care settings.