OBJECTIVES: Our aim was to evaluate virtual reality's effects in dyspnoea's management. METHODS: Information sources: Trials were identified through a systematic search carried out on MEDLINE, Web of Science, Scopus and CINAHL until 17 March 2025. ELIGIBILITY CRITERIA: Eligible studies were controlled trials including adults with dyspnoea associated with respiratory diseases, for whom virtual reality was implemented and compared with another intervention. Risk of bias: Risk of bias (ROB) was assessed using the ROB 2 tool. SYNTHESIS OF RESULTS: The primary outcome was dyspnoea. Secondary outcomes included exercise capacity, health-related quality of life (HRQOL) and muscle function. Effect size was expressed using standardised mean difference (SMD) or MD for primary and secondary outcomes, respectively (random-effects model). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. RESULTS: Included studies: 13 studies were selected, including 483 adults and using non-immersive tools (n = 7) or immersive tools (n = 6). Risk of bias in these studies was low (n = 1), some concerns (n = 8) and high risk (n = 4). SYNTHESIS OF RESULTS: No difference was found in dyspnoea (8 studies, 224 participants; SMD 0.02, 95% CI -0.82 to 0.86, I2 88.2%), exercise capacity (5 studies, 183 participants; MD 3.62, 95% CI -19.39 to 26.63, I2 39.8%) and in HRQOL (4 studies, 127 participants; MD -11.81, 95% CI -42.95 to 19.33, I2 98.9%). The data available were insufficient to conduct a pooled analysis for muscle function. CONCLUSIONS: Limitations of evidence: The evidence is very uncertain about virtual reality's effects on dyspnoea due to risk of bias, imprecision and heterogeneity. INTERPRETATION: Further studies are needed and should explore various aspects of the application of immersive virtual reality. PROSPERO REGISTRATION NUMBER: CRD42023443280.

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