{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:14Z","timestamp":1782283574188,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:p>Dyspnea in chronic obstructive pulmonary disease (COPD) is often treated as the perceptual consequence of altered airflow, lung volume, gas exchange, or work of breathing. Yet breathlessness is not a unitary symptom or a direct readout of pulmonary dysfunction. It comprises at least three partially dissociable sensations-air hunger, breathing effort, and chest tightness-with distinct physiological triggers and affective salience. Current models suggest that conscious breathlessness emerges from the interaction of respiratory motor drive, corollary discharge, sensory afferent feedback, central integration, and higher-order interoceptive inference. In COPD, this framework helps explain why dyspnea may diverge from spirometric impairment and why symptom burden can remain high despite appropriate treatment. This Perspective develops a hypothesis-generating conceptual model for pulmonary rehabilitation, rather than a systematic or scoping review. We argue that respiratory biofeedback may be relevant not only because it can modify breathing pattern, but also because it may help test whether changing perceived control, autonomic regulation, and affective responses to respiratory signals can influence rehabilitation-relevant outcomes. Our recent pilot trial in late-stage COPD is compatible with this interpretation, but it did not directly test cognitive-affective mechanisms of action. From this perspective, neurofeedback should not be considered an established treatment for dyspnea, but a plausible future translational research question for selected highly symptomatic patients. Extension of this framework beyond COPD to other chronic respiratory diseases requires condition-specific validation.<\/jats:p>","DOI":"10.3389\/fresc.2026.1844949","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:11Z","timestamp":1782279971000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking dyspnea in pulmonary rehabilitation: from respiratory load and interoceptive processing to biofeedback and neurofeedback"],"prefix":"10.3389","volume":"7","author":[{"given":"Gianvito","family":"Lagravinese","sequence":"first","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Bari Institute","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Castellana","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, Bari Institute","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pasqualotto","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, Bari Institute","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Carone","sequence":"additional","affiliation":[{"name":"Istituti Clinici Scientifici Maugeri IRCCS, Pneumology and Respiratory Rehabilitation Unit, Bari Institute","place":["Bari, Italy"]},{"name":"Department of Medical and Surgical Sciences, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Taurisano","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro","place":["Bari, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1513\/AnnalsATS.202102-146ST","article-title":"Defining modern pulmonary rehabilitation: an official American thoracic society workshop report","volume":"18","author":"Holland","year":"2021","journal-title":"Ann Am Thorac Soc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e7","DOI":"10.1164\/rccm.202306-1066ST","article-title":"Pulmonary rehabilitation for adults with chronic respiratory disease: an official American thoracic society clinical practice guideline","volume":"208","author":"Rochester","year":"2023","journal-title":"Am J Respir Crit Care Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1164\/rccm.201111-2042ST","article-title":"An official American thoracic society statement: update on the mechanisms, assessment, and management of dyspnea","volume":"185","author":"Parshall","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"104441","DOI":"10.1016\/j.resp.2025.104441","article-title":"The potential role of the anterior insular cortex and interoception on dyspnea in chronic obstructive pulmonary disease","volume":"336","author":"Hudson","year":"2025","journal-title":"Respir Physiol Neurobiol"},{"key":"B5","first-page":"309","article-title":"Dyspnea","volume-title":"Handbook of Clinical Neurology. 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