A sample of 37 patients with severe chronic obstructive pulmonary disease (COPD) drawn from a larger group of 64 patients being studied in a randomized trial of nebulizer versus high-dose inhaler therapy, and similar in age and gender mix, was interviewed in depth, with a view to illuminating standardized outcome measures and improving the understanding of these patients' needs. Three patients are described in detail. The interview material was analysed using non-computerized methods. Quality of life was seen as depending mainly on family relationships, opportunities afforded locally for neighbourliness and freedom from fear, mobility and independence in the activities of daily living, and the absence or successful mitigation of symptoms of concomitant disease. Disease-specific, symptom-oriented outcome measures may miss these. Additionally, the near and repeatedly threatening approach of death recommended extension of a palliative approach to endstage COPD.