Background: Previous studies of the qualitative sensation of breathlessness have suggested that greater sensory discomfort is reported as airflow obstruction increases. This study investigated relationships between the language of breathlessness and severity of impairment in subjects with COPD. Methods: Using a prospective, observational approach, subjects completed a structured interview in which they volunteered words to describe their sensation of breathlessness and endorsed statements from a preexisting descriptor list. Global impairment was assessed by the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Independent t tests and logistic regression analyses (odds ratios) were used to assess relationships between language categories and severity of impairment. Results: In this group of 91 people (47 men, 70 ± 10 years of age, percent predicted FEV1 54 ± 23), subjects volunteering extreme affective descriptors (frightening, awful, worried) had greater impairment (BODE index, perceived respiratory disability, functional exercise capacity, and airways obstruction), and this language category was significantly associated with increasing BODE index scores (odds ratio [OR] = 1.49; 95% CI, 1.18 to 1.86; P = .001). Descriptors denoting heavy, rapid, more, shallow, or does not go in or out all the way were significantly less likely to be selected as BODE index scored increased (OR = 0.75; 95% CI, 0.16 to 0.93). Conclusions: Affective descriptors or the emotional response to the sensation of breathlessness have a significant relationship with severity of COPD impairments. Affective descriptors may reflect the degree of threat imposed by the sensation and predict the likelihood of long-term behavioral changes.