Twenty years ago, the case was made for people with life-limiting medical conditions other than cancer to receive specialist palliative care services. The recommendation came from the National Council for Hospice and Specialist Palliative Care Services ( Addington Hall, 1998 ). Since then, research and practice have developed to make this a reality. We now see people with non-curative medical conditions, often referred to as being in the end stages of their chronic condition, receiving care and treatment by palliative care practitioners. There is, however, a long way to go before the rhetoric of 'palliative care for all' becomes a reality. Few people with end-stage pulmonary disease have access to hospice and specialist palliative care services. This article focuses on end-stage pulmonary disease, a term that encompasses all non-malignant, chronic lung conditions that progress to end-of-life care. An overview of the pathophysiology of the condition is given. Focus is placed on the stages of the disease and common patient problems, using case studies to highlight how the disease processes develop to become end stage and require palliative care. The article highlights the need for care planning at the end of life and the palliative care measures required to ensure good quality care centred on both physical and psychosocial aspects.