Palliative care in COPD: an unmet area for quality improvement Julia H Vermylen,1 Eytan Szmuilowicz,2 Ravi Kalhan3 1Department of Medicine, 2Section of Palliative Medicine, Department of Medicine, 3Asthma and COPD Program, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patient’s course causing referrals to occur late in a patient’s disease. Additionally, physicians avoid conversations about advance care planning due to unique communication barriers present with patients with COPD. Lastly, many health systems are not set up to provide trained palliative care physicians to patients with chronic disease including COPD. This review analyzes the above challenges, the available data regarding palliative care applied to the COPD population, and proposes an alternative approach to address the unmet needs of patients with COPD with proactive primary palliative care. Keywords: advance care planning, primary palliative care, end-of-life care, advanced lung disease, quality of life, prognosis