Breathlessness in advanced disease

Breathlessness is the subjective experience of breathing discomfort, which arises as a distressing symptom in many diseases. It has several pathophysiological causes involving peripheral and central receptors and is modulated by cortical processing including emotions. Older people and patients with sarcopenia or cachexia are more susceptible to breathlessness on exertion. In the last hours of life, breathing can become laboured and noisy, owing to upper airway secretions. Most patients can be assessed by physical examination and simple investigations.