Table 2 In- and exclusion criteria

Inclusion criteria

Age ≥ 40 years

Read, understood and signed the Informed Consent form

COPD GOLD class III or IV, according to GOLD criteria

 Post-bronchodilatation FEV1/FVC ≤ 70% and FEV1 < 50% pred.*

Complaints of refractory dyspnea as established by patient and doctor

mMRC score ≥ 3

Life expectancy of ≥ 2 months

Optimized standard therapy according to Dutch LAN guideline for diagnosis and treatment of COPD

Exclusion criteria

Other severe disease with chronic pain or chronic dyspnea (a non-susbstantial component of left sided heart failure is acceptable)

Current use of opioids for whatever indication

Allergy/intolerance for opioids

Psychiatric disease, not related to severe COPD

Exacerbation of COPD 8 weeks prior to inclusion or between screening and randomization

Problematic (leading to medical help or social problems) substance abuse during the last 5 years

Active malignancy, with the exception of planocellular or basal cell carcinoma of the skin

eGFR < 15 ml/min*