Based on 2004 data, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world, surpassed only by cardiovascular disease, pneumonia and HIV/AIDS. The terminal trajectory of patients with COPD is distinct from that of cancer patients. The unpredictability of prognosis for people with COPD poses different challenges in end-of-life decision-making from those faced by individuals with terminal cancer. The use of a traditional cancer-based service model to predict the need for palliative care services is not helpful for people with COPD. Drastic improvements in end of life care for the people with COPD are essential, especially with the projected rise in cases over the coming years.