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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 (<jats:italic>e.g.<\/jats:italic>, 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.<\/jats:p>","DOI":"10.1183\/20734735.0096-2024","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T09:25:17Z","timestamp":1742289917000},"page":"240096","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Assessment of breathlessness: a pulmonologist's perspective \u2013 short of breath, but not short of answers"],"prefix":"10.1183","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6655-6130","authenticated-orcid":false,"given":"Ruaidhr\u00ed","family":"Keane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Brennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"2025031821300882000_21.1.240096.1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.159.1.ats898"},{"key":"2025031821300882000_21.1.240096.2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00092613"},{"key":"2025031821300882000_21.1.240096.3","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0534"},{"key":"2025031821300882000_21.1.240096.4","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(90)90065-7"},{"key":"2025031821300882000_21.1.240096.5","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00594.2002"},{"key":"2025031821300882000_21.1.240096.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2006.01.016"},{"key":"2025031821300882000_21.1.240096.7","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm\/142.5.1009"},{"key":"2025031821300882000_21.1.240096.8","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.155.1.9001298"},{"key":"2025031821300882000_21.1.240096.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.4.1072"},{"key":"2025031821300882000_21.1.240096.10","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1152\/jappl.1998.84.6.2000","article-title":"Qualitative aspects of exertional dyspnea in patients with interstitial lung disease","volume":"84","author":"O'Donnell","year":"1998","journal-title":"J Appl Physiol (1985)"},{"key":"2025031821300882000_21.1.240096.11","doi-asserted-by":"crossref","first-page":"271A","DOI":"10.1016\/j.chest.2019.02.261","article-title":"Sighing dyspnea: one cause of medically unexplained dyspnea; the results of clinical testing and treatment using a breathing technique","volume":"155","author":"Bergstrom","year":"2019","journal-title":"Chest"},{"key":"2025031821300882000_21.1.240096.12","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0308"},{"key":"2025031821300882000_21.1.240096.13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.117.4.935"},{"key":"2025031821300882000_21.1.240096.14","doi-asserted-by":"crossref","first-page":"S2117","DOI":"10.21037\/jtd.2019.10.53","article-title":"Diagnostic approach to chronic dyspnoea in adults","volume":"11: Suppl. 17","author":"Ferry","year":"2019","journal-title":"J Thorac Dis"},{"key":"2025031821300882000_21.1.240096.15","doi-asserted-by":"publisher","DOI":"10.1136\/thx.54.7.581"},{"key":"2025031821300882000_21.1.240096.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2010.12.009"},{"key":"2025031821300882000_21.1.240096.17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1093\/abm\/kaab045","article-title":"Caregiver experiences and roles in care seeking during COPD exacerbations: a qualitative study","volume":"56","author":"Suresh","year":"2022","journal-title":"Ann Behav Med"},{"key":"2025031821300882000_21.1.240096.18","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.rmed.2012.12.018","article-title":"Dyspnea and emotional states in health and disease","volume":"107","author":"Scano","year":"2013","journal-title":"Respir Med"},{"key":"2025031821300882000_21.1.240096.19","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.chest.2020.09.251","article-title":"Dyspnea, acute respiratory failure, psychological trauma, and post-ICU mental health: a caution and a call for research","volume":"159","author":"Worsham","year":"2021","journal-title":"Chest"},{"key":"2025031821300882000_21.1.240096.20","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201111-2042ST"},{"key":"2025031821300882000_21.1.240096.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2006.07.003"},{"key":"2025031821300882000_21.1.240096.22","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1989.00390100089021"},{"key":"2025031821300882000_21.1.240096.23","unstructured":"Global Initiative for Asthma . 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