People with non-malignant diseases accessed palliative care later. Functional decline was similar in the two groups and accelerated in the last month of life. Four months before death, median AKPS was 40 in lung cancers and 30 in non-malignant end-stage respiratory diseases (p<0.001). In lung cancers (89 904 observations 18 586 patients) and non-malignant end-stage respiratory diseases (14 827 observations 4279 patients), age at death was significantly lower in people with lung cancer (73 years IQR 65–81) than non-malignant end-stage respiratory diseases (81 years IQR 73–87 years p<0.001). Five years of data used Joinpoint and weighted scatterplot smoothing. The Australian national Palliative Care Outcomes Collaboration collects functional status (Australia-modified Karnofsky Performance Status (AKPS)) and symptom distress (patient-reported 0–10 numerical rating scale) in inpatient and community settings. To compare functional decline and symptom distress in advanced malignant and non-malignant lung diseases using consecutive, routinely collected, point-of-care national data. Despite similar symptom burdens, serious inequities in access to palliative care persists for people with non-malignant respiratory diseases. Malignant and non-malignant respiratory diseases account for >4.6 million deaths annually worldwide. Symptom trajectories on the population level reflecting the whole group mask individual variation, which is reflected in distinct symptom trajectories with different patterns. These revealed wide individual variations with four different patterns: fluctuation, increasing, stable and decreasing breathlessness. Twenty-one cancer and 43 COPD patients provided data for individual breathlessness trajectories. In COPD patients, breathlessness increased over time. In cancer patients, breathlessness increased towards death. Thirty out of the 49 cancer and 6/60 COPD patients died, 7/49 cancer and 20/60 COPD patients dropped out due to physical deterioration or questionnaire fatigue.

Forty-nine cancer and 60 COPD patients were included.

Data were collected at baseline and then monthly over six months or until death. The modified Borg Scale, Memorial Symptom Assessment Scale Short Form and Palliative Outcome Scale were used as outcome measures. This study aimed to describe and compare the summary and individual trajectories of breathlessness and overall symptom burden over time and towards the end of life following patients with advanced cancer or severe chronic obstructive pulmonary disease (COPD) in inpatient and outpatient health care settings in Germany. Little is known about the trajectories of this symptom over time and towards death. Breathlessness is a distressing symptom in advanced disease.

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