Objective To explore the influencing factors and the pathway of dyspnea-related fear in patients with chronic obstructive pulmonary disease (COPD), and to provide a reference for conducting targeted intervention to alleviate their dyspnea-related fear. Methods A total of 376 COPD patients were selected by the convenience sampling method, then they were investigated by utilizing a general information questionnaire, the modified Medical Research Council (mMRC), the Hospital Anxiety and Depression Scale (HADS), the Chinese version of the Breathlessness Catastrophizing Scale (BCS) , the COPD Self-efficacy Scale (CSES), and the Breathlessness Beliefs Questionnaire (BBQ). Results The participants′ score of dyspnea-related fear was 20.0 (17.0, 22.0). Mul-tivariate analysis showed that,the scores of BCS, CSES, HADS, and Body Mass Index (BMI) were influencing factors of dyspnea-related fear in COPD patients (all P<0.05). The results of structural equation model were:χ2/df=1.468, RMSEA=0.035, GFI=0.997, AGFI=0.973, NFI=0.999, IFI=1.000, CFI=1.000, TLI=0.997, which showed good fitting. Pathway analysis showed that, the direct affect effects of catastrophizing cognition, self-efficacy, anxiety and depression on dyspnea-related fear were 0.534, -0.362, 0.196, -0.113, respectively, and dyspnea indirectly affected dyspnea-related fear via anxiety, depression, catastrophizing cognition and self-efficacy (all P<0.05). Conclusion Dyspnea-related fear in COPD patients is at a high level, which is influenced by multiple factors. Clinical medical staff should develop personalized intervention strategies by considering patients′ individual, psychological and other influencing factors and the pathways, so as to reduce their dyspnea-related fear.