Edith aged 75 years was diagnosed with COPD seven years ago. She lives with her husband John and son Michael who has a learning disability. She has been a smoker for 50 years and occasionally still has a cigarette. Edith also has a history of anxiety and hypertension. Her breathlessness has worsened over the past year and she finds it increasingly difficult to manage at home. She has ambulatory oxygen of 1 liter via nasal cannula and is on inhalers, nebulizers as well as long-term prophylactic antibiotics, and yearly flu vaccine.

In the past year, she has been admitted to the hospital with exacerbations of her COPD where she received intravenous antibiotics and steroids. Her appetite is poor and she has lost weight over the past few months. Her main issue is breathlessness which she is frustrated with and is often exhausted trying to manage basic activities like washing and dressing. She has support from her public health nurse and GP as well as the respiratory consultant but is reluctant to accept support from palliative care for the time being. She is finding her situation overwhelming and has difficulty discussing it.