Activity-related dyspnea in chronic obstructive pulmonary disease: physical and psychological consequences, unmet needs, and future directions

Int J Chron Obstruct Pulmon Dis. 2019 May 24;14:1127-1138. doi: 10.2147/COPD.S188141. eCollection 2019.


Dyspnea is a distressing, debilitating, and near-ubiquitous symptom affecting patients with COPD. In addition to the functional consequences of dyspnea, which include activity limitation and reduced exercise tolerance, it is important to consider its psychological impact on patients with COPD, such as onset of depression or anxiety. Moreover, the anticipation of dyspnea itself can have a significant effect on patients' emotions and behavior, with patients frequently self-limiting physical activity to avoid what has become the hallmark symptom of COPD. Dyspnea is, therefore, a key target for COPD treatments. Pharmacologic treatments can optimize respiratory mechanics, provide symptom relief, and reduce patients' increased inspiratory neural drive to breathe. However, it is important to acknowledge the value of non-pharmacologic interventions, such as pulmonary rehabilitation and patient self-management education, which have proven to be invaluable tools for targeting the affective components of dyspnea. Furthermore, it is important to encourage maintenance of physical activity to optimize long-term patient outcomes. Here, we review the physiological and psychological consequences of activity-related dyspnea in COPD, assess the efficacy of modern management strategies in improving this common respiratory symptom, and discuss key unmet clinical and research needs that warrant further immediate attention.

Keywords: chronic obstructive pulmonary disease; dyspnea; management; physiology; psychology.

Publication types

  • Review

MeSH terms

  • Adaptation, Psychological
  • Animals
  • Bronchodilator Agents / therapeutic use
  • Cost of Illness*
  • Dyspnea / diagnosis
  • Dyspnea / physiopathology*
  • Dyspnea / psychology
  • Dyspnea / therapy
  • Exercise Tolerance* / drug effects
  • Exercise*
  • Health Services Needs and Demand
  • Health Status
  • Humans
  • Lung / drug effects
  • Lung / physiopathology*
  • Mental Health
  • Needs Assessment
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Respiratory Therapy
  • Risk Factors
  • Treatment Outcome


  • Bronchodilator Agents