Pere Almagro,1 Pablo Martinez Camblor21Multimorbidity Patients Unit, Internal Medicine Department, Hospital Universitario Mutua de Terrassa, Universidad de Barcelona, Terrassa, Barcelona; 2The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USAWe read with interest the recent article by Duenk et al entitled "Development of the ProPal-COPD tool to identify patients with COPD for proactive palliative care" recently published in the International

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... of Chronic Obstructive Pulmonary Disease.1 We fully agree with the authors on the capital importance of proactive palliative care (PPC) in COPD, as well as its underutilization. Any article that contributes to increasing knowledge of PCC and its use with COPD patients who can benefit from it is to be celebrated. We also agree with the authors on the unpredictability of prognosis in COPD, especially the uncertain evolution of severe exacerbations and the impact of comorbidities.View the original paper by Duenk and colleagues.