The most common end-stage pulmonary disease seen in hospice settings, after lung cancer, is chronic obstructive pulmonary disease (COPD). Patients who have stable COPD can be treated with a variety of medications to improve gas exchange, ease the work of breathing, and reduce the risk of COPD exacerbation. Smoking cessation should be addressed with every patient who has COPD. Patients who have COPD should receive annual vaccinations to help prevent exacerbations of COPD. Both pharmacological and nonpharmacological interventions should be used to manage symptoms of COPD. An advanced care plan should be discussed early in the disease process. Hospice care should be discussed with the patient and family when it is consistent with the patient's goals. This chapter helps the nurse to identify key symptoms associated with COPD, determine the factors that increase risk of COPD exacerbation, and explain the hospice admission criteria for pulmonary disease.