We present a case where we evaluated the effectiveness of nebulized fentanyl in the treatment of refractive dyspnea in a patient with chronic obstructive pulmonary disease (COPD) with major complications and comorbidities. Nebulized fentanyl was used to successfully decrease the subjective symptoms of refractory dyspnea in this given patient. Nebulized fentanyl appears to be a cost-effective treatment option in patients that experience episodes of severe shortness of breath (SOB).