Breathlessness is a common and distressing symptom in advanced cancer. Management comprises non-pharmacological and pharmacological interventions, which are best combined. There is some evidence mainly derived from COPD studies for walking aids, neuro-muscular electrical stimulation, fan and breathlessness services. Opioids are the drugs of choice for pharmacological management of breathlessness. There is currently not enough evidence to support the routine use of benzodiazepines, other anxiolytics, antidepressants, phenothiazines, inhaled furosemide and oxygen.