Purpose of review: This review aims to define and explore the contribution of occupational therapy in end-of-life care, with a particular focus on breathlessness. It examines occupational therapy interventions for the management of breathlessness and makes recommendations for future research. Recent findings: An emerging body of research demonstrates people with advanced disease continue to strive for active participation in everyday activities in the face of debilitating symptoms such as breathlessness. It is through active participation that people adjust to bodily decline. When specific everyday activities are targeted for intervention, implantation of strategies to manage breathlessness within the context of these activities has been found to optimize function and well being for those with chronic obstructive pulmonary disease. Evidence examining the efficacy of energy conservation and relaxation is limited and requires more robust examination. Summary: Symptoms such as dyspnoea need to be considered within the contexts in which they exist - that is, the bodily experience of breathlessness and its impact on everyday activities or occupations. The clinical and theoretical focus of occupational therapy supports the enablement of continued participation in valued and essential activities and offers a unique focal point for research. Emerging research demonstrates the importance of translating the benefits of effective symptom management into everyday activities and informs a future research agenda.