Patients experiencing a dyspnea exacerbation will often report feeling smothered or suffocated. This highly distressing, prevalent, multidimensional symptom is the chief complaint signifying pulmonary dysregulation. Increasing dyspnea intensity heralds the onset of respiratory failure, leading to hospitalization and/or admission to the intensive care unit (ICU). Dyspnea can only be known from the patient’s report about the personal experience. However, many ICU patients experience temporary or permanent cognitive impairment precluding a symptom report; thus, a behavioral assessment is indicated. Comprehensive dyspnea assessment informs subsequent treatment. Conventional treatment of dyspnea includes reducing or eliminating the underlying cause, mechanical ventilation, supplemental oxygen, balancing rest with activity, and positioning. Opioids and benzodiazepines reduce dyspnea and the associated fear or anxiety and are most often used to maintain ventilator–patient synchrony, in terminal illness or during the withdrawal of mechanical ventilation. Inhaled furosemide is under investigation as an alternative to opioids. The focus of this article is to provide an evidence-based approach to nursing assessment and management of dyspnea.