Inclusion Criteria:  diagnosed COPD stage III or stage IV Nutritional risk by screening (NRS-2002)(Kondrup et al, 2002) and/or low-fat free mass (FFMI) (≤ 15% for women and ≤ 16% for men) measured by Bioelectrical Impedance Analysis (BIA)  Exclusion Criteria:  Terminal phase of COPD Lung transplanted patients  Severe Comorbidities influenzing the end-points (pancreatic insufficiency, severe hepatic failure, inflammatory gastrointestinal disease)  Multiple sclerosis Any unwillingness or inability (e.g. not able to make notes of their nutritional intake, come to consultations or manage oral intake)