The goal of palliative care is to prevent suffering and manage symptoms, maintain quality of life, and provide physical, emotional, and spiritual support for patients and their loved ones. Research suggests that patients with chronic lung disease receive suboptimal palliative care largely because of inadequate communication with their physicians. When patients have made decisions about life-sustaining therapies, physicians often either do not know patients' wishes or misunderstand them. Clinicians should realize that most patients want more information about end-of-life care and that efforts to initiate and improve communication with their patients are important. This article reviews the potential for enhanced palliative care for older patients with chronic lung disease.