Aims : to increase awareness of the differential diagnosis of patients with unexplained breathlessness, including discussion of laryngeal dysfunction, dysfunctional breathing and unusual causes of refractory/unexplained breathlessness in pulmonary practise; to explain how to evaluate unexplained breathlessness using the best diagnostic tests, including cardiopulmonary exercise testing and continuous laryngoscopy during exercise testing; and to discuss diagnostic tips and clinical strategies to improve clinical practise in cases of unexplained breathlessness.