~ Cues linked to breathlessness trigger sensations even without the original cause.
~ Negative emotions like anxiety and depression play a significant role in breathlessness perception.
~ Anxiety and depression often coexist with respiratory issues, intensifying breathlessness.
~ You would feel more out of breath when you're in a place or situation that reminds you of something bad or uncomfortable.
~ When you're feeling scared or sad, even small things like a certain smell or sound can make you feel even more out of breath than usual.
~ The way we learn things and how we act can make us keep feeling out of breath.

Extensive research has delved into the physiological mechanisms underlying breathlessness, revealing a recent focus on the profound impact of expectation and emotional state. Notably, individuals with asthma can experience breathlessness triggered by cues associated with it, like the sound of wheezing. Intriguingly, even returning to a location where breathlessness was previously felt can evoke the sensation, even in the absence of the original trigger. This intriguing phenomenon is attributed to the brain’s generation of predictions based on past encounters, leading to breathlessness in specific contexts, such as within the confines of a subway.

Functional imaging studies have unveiled a glimpse into this phenomenon, pinpointing certain brain regions that activate during the anticipation of breathlessness. These include the anterior insula, anterior cingulate, prefrontal cortex, and midbrain structures like the ventrolateral periaqueductal gray (PAG). Notably, these regions are recognized as pivotal in processing emotions and affective responses, particularly negative ones like anxiety and depression. This is significant considering that anxiety and depression often accompany respiratory conditions, exacerbating breathlessness. For instance, anxiety sensitivity, which encompasses anxiety towards bodily sensations, appears to influence an individual’s perception of breathlessness.

The potency of perceptions and predictions in shaping breathlessness perception hinges on the precision ascribed to them. The greater the precision attributed to a prediction or sensory input, the more reliance is placed on that signal, significantly impacting the final experience of breathlessness. Moreover, susceptibility to contextual cues emerges as a pivotal factor in connecting breathlessness and predictions. Negative affect amplifies the influence of contextual cues on perception, heightening sensitivity to them. Intriguingly, negative cues hold more sway over breathlessness in susceptible individuals compared to positive cues, exemplified by foul odors and explicit suggestions of discomfort.

The intricate interplay is further complicated by the presence of factors that fortify perceptual expectations regarding breathlessness, including learning biases and behavioral adaptations to align with these expectations. The amalgamation of these factors can create a resilient framework, potentially resisting changes in perceptual expectations related to breathlessness.

In essence, the evolving understanding of breathlessness underscores the intricate dance between expectation, emotion, and context. By unraveling these multifaceted connections, researchers gain insights that can guide interventions and therapies, particularly for individuals grappling with respiratory conditions and the associated challenges of breathlessness.


Marlow, L. L., Faull, O. K., Finnegan, S. L., & Pattinson, K. (2019). Breathlessness and the brain: the role of expectation. Current opinion in supportive and palliative care13(3), 200–210. https://doi.org/10.1097/SPC.0000000000000441

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