Abstract
We congratulate Curtis on his excellent review on the very important and under-recognised topic of palliation in end-stage chronic obstructive pulmonary disease (COPD). We agree that the use of noninvasive ventilation (NIV) as palliation may be impractical in the hospice environment, and that NIV should not be used first-line for the palliation of breathlessness in COPD. However, we do not think that there is sufficient recognition that in certain specific circumstances NIV may have a role in end-stage COPD.