Background <p>Spiritual distress appears common in people with advanced chronic obstructive pulmonary disease but is likely to be under-reported. Evidence indicates that spiritual distress becomes more intense during periods of hospitalisation when physical symptoms are exacerbated. Existing evidence on how such distress is experienced is mainly drawn from the Western context, which may not be appropriate to guide care for those from other cultures and contexts. The experience of spiritual distress in people with advanced chronic obstructive pulmonary disease in India is explored in this study.</p> Methods <p>A descriptive, phenomenological approach was employed. People (<i>n</i> = 15) who were hospitalised with advanced chronic obstructive pulmonary disease were purposively sampled from an Indian tertiary care hospital in 2017. Unstructured interviews were conducted, audio-recorded, then transcribed. Analysis followed Giorgi’s method and themes related to spiritual distress were developed.</p> Results <p>Three main themes were identified. (i) Purposeless life: repeated hospitalisation with acute breathlessness caused purposelessness but completing family responsibilities gave a sense of fulfilment. (ii) Despair and hope: extreme thoughts of ‘wishing to die but wanting to live’ were experienced alternately. (iii) Discontentment and death wish: Suffering caused feelings of abandonment by God, which triggered death wishes.</p> Conclusions <p>This study has indicated that family and God were central to coping with spiritual distress during hospitalisation in Indian people with advanced chronic obstructive pulmonary disease. Identifying spiritual distress in its context and culture and the utilisation of appropriate spiritual support are important for palliative care professionals providing care to culturally diverse populations.</p>