Breathlessness (or dyspnoea) is a common symptom in patients with cancer and other advanced progressive illnesses such as cardiac failure, chronic obstructive pulmonary disease and pulmonary fibrosis. It is often distressing for both the patient and the carer. Management of breathlessness starts with a good history and examination. Various reversible causes and possible treatments are outlined. A multidisciplinary approach with non-pharmacological and drug-based approaches to symptomatic relief of breathlessness is generally necessary, the latter predominating as death approaches.