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Caring for individuals with advanced chronic obstructive pulmonary disease (COPD) with refractory breathlessness is undoubtedly challenging and I commend the authors for undertaking important and necessary research in this area. I did not write that opioids ‘should not be used’ in patients with advanced COPD.1 Based on the authors’ own data showing significantly increased all-cause mortality among individuals with advanced COPD receiving benzodiazepine and ‘high-dose’ opioids,2 I expressed that some caution should be displayed when prescribing these medications to these older, respiratory-vulnerable patients, …