Aimed at acknowledging the lung-brain axis, behavioral-functional and psychosocial-spiritual dimensions of the breathlessness experience. Also takes into account integrated mechanisms, differing phenotypes of the same complaint and response to therapy. May be used to predict and target responses to treatment. A circular bidirectional relationship where breathlessness and anxiety constitute inseparable entities has also been proposed.

The following triggers might be used to characterize the patient’s experience
When you breathe in, are you tensing your shoulders to lift your chest up.
To exhale, do you force the air out?
Are you breathing very rapidly?
do you find yourself holding your breath, when you need to move?

Breathlessness triggered support service is envisaged as a partnership between respiratory medicine and palliative care. Typical breathlessness support services focus on rehabilitation and self-management of breathlessness. The contribution of the respiratory physician in adding an element of accountability to service provision has been acknowledged (“patients tend to feel more comfortable when their x-rays are discussed in front of them”) , whilst the palliative team provides philosophical allegiance to dignity focused, patient centered provision. A possible criticism could be the lack of a scientific heft associated with the holistic assessment ascribed to palliative care and requires rectification (based upon assumed posturing, Can the specialist’s interpretation of the X-Ray be trusted in the same manner?).

References
Higginson, I. J. (2026). The LOROS Lecture 2026: Breathlessness – An overlooked challenge, learning and unlearning evidence [Lecture]. LOROS Hospice.

Bleazard, L., Walker, K., Ashton, S., & Faull, C. (2025). ‘It helps my anxiety because I’m managing my breathlessness’: A qualitative exploration of anxiety and breathlessness in patients with advanced chronic respiratory disease receiving specialist palliative care. medRxiv. https://doi.org/10.1101/2025.09.03.25334785