Assessment of breathlessness: a pulmonologist's perspective - short of breath, but not short of answers.

Breathlessness, or dyspnoea, is a complex symptom influenced by respiratory, cardiovascular and neural mechanisms, necessitating a systematic and tiered approach for accurate diagnosis and effective management. This review presents a structured, three-tier diagnostic framework, comprising history-taking, static testing (such as pulmonary function tests and thoracic imaging), and dynamic testing (e.g., 6-minute walk test and cardiopulmonary exercise testing) for comprehensive assessment. Each tier is designed to progressively investigate and characterise underlying conditions. This framework is specifically tailored for use in an outpatient general respiratory clinic setting, where clinicians evaluate chronic or unexplained dyspnoea in non-acute patients. Literature and guidelines support this approach, highlighting the importance of combining clinical examination, imaging, laboratory testing and dynamic assessments to capture both static and exertional components of dyspnoea. Emphasising a patient-centred approach, this framework aims to improve diagnostic accuracy and guide targeted therapeutic interventions.