Patients with advanced COPD struggle to access the necessary support to manage daily life in a strained healthcare system

<bold>Main text:</bold> The traditional organization of respiratory outpatient clinics is evolving towards a responsive approach to meet the dynamic needs of the patients. However, gaps persist in understanding patients’ perspectives and needs, particularly concerning self-management strategies and interaction. <bold>Aims:</bold> To explore the self-management strategies of Danish patients living with advanced COPD, particularly focusing on interactions with the respiratory outpatient clinic. <bold>Methods:</bold> A qualitative study. Data were collected through interviews with eleven patients with advanced COPD and thematically analyzed following the method described by Braun & Clarke (2014). <bold>Results:</bold> The overarching theme "In a strained Healthcare System patients with COPD struggle to access needed support to be able to self-manage their disease" was revealed and supported by three main themes: 1) Only physical symptoms provide legal access to the respiratory outpatient clinic 2) For patients, measured values reflect health status and well-being 3) Healthcare professionals' skills and not the mode of contact matters to the patients. <bold>Conclusions:</bold> Findings emphasize the need for a patient-centered approach recognizing holistic needs and barriers to self-management. Healthcare professionals should understand the strained system's impact on patient behavior, noting that advanced COPD patients might avoid burdening the system, potentially neglecting symptoms, and risking disease progression.