The Chronic Breathlessness: Delivering an Early and Accurate Diagnostic Pathway Webinar was held on Wednesday 28 May 2025 at 11:00 – 12:00
This Webinar includes:
- An introduction to the NHSE Adult Breathlessness Pathway (pre diagnosis)
- Case example – George Eliot Hospital NHS Trust
- Case example – The Royal Wolverhampton NHS Trust
- An opportunity for you to ask questions to our panel
The Panel:
- Dr Karl Sylvester
- Dr Helen Ward
- Joanna Purvis
- Andrew Pritchard
FAQs below
Breathlessness Pathways – Frequently asked questions
Who can refer into the Community Diagnostic Centres (CDCs)?
Any healthcare professional clinically supporting and responsible for the patient can refer. This does not have to be a medical doctor.
Are we restricted on which CDCs we can refer to? What if we don’t have one local to us just yet?
Patients can be referred into any CDC they are willing to travel to. There are no location restrictions.
There are lots of breathlessness pathways in development that have been funded by the CDC programme so please reach out to the CDC team to see if there is a pathway in development or soon to be in development. england.cdcprogramme@nhs.net
Do we have to refer to a clinical specialist first, e.g. a respiratory consultant, before/ as well as into the CDC?
No. A direct referral into the pathways being led by Healthcare Scientists is all that is required.
Where can we find information on these breathlessness pathways?
Further more detailed information can be found here NHS England » Adult breathlessness pathway (pre-diagnosis): diagnostic pathway support tool
What training and competency is require for Healthcare Scientists to undertake tasks such as clinical examination and clinical history taking?
Feedback from the presenters outlined “I spent many months on ward rounds twice a week and went to clinic with consultants in respiratory, cardiology etc, first I shadowed them and would then lead the clinics under their direct supervision. I would have a discussion with them after the clinics about the patient etc and then once my consultant deemed me competent I then went solo in clinic. I also attended many courses especially clinical assessment and imaging” Although many Healthcare Scientists leading on these pathways are undertaking the Higher Specialist Scientific Training (HSST) programme, there are more skills needed beyond this programme. There are lots of providers offering courses on clinical examination, history taking and interpreting imaging, including Higher Education Institutions or the British Thoracic Society. We would encourage readers to search out the most appropriate course and provider for them.
What defines these as breathlessness pathways as opposed to a respiratory pathway?
The breathlessness pathway is for patients with chronic breathlessness of more than 8 weeks and no diagnosis. A respiratory pathway may be used for other presentations or other patients with known diagnosis but under managed.
Can we refer patients with chronic cough into the breathlessness pathway?
Breathlessness pathways have not been designed to support patients whose only symptom is chronic cough. We would still suggest referring these into specialist centres.
Where can I access some of the questionnaires discussed on the webinar, e.g. PHQ4, BPAT etc?
PHQ4 - https://www.capc.org/documents/download/467/
BPAT - https://physiotherapyforbpd.org.uk/BPAT.pdf
Nijmegen - https://www.physiotherapyforbpd.org.uk/Nijmegen-Questionnaire-2019.pdf
What is a Mannitol Test?
Mannitol test uses mannitol, which is a powdered sugar, and is a breathing test which assesses how sensitive the patients airways are. Used to rule-in a diagnosis of asthma.
What are the findings on CPET to diagnose breathing pattern disorder?
Usually an abnormal variability in breathing frequency and tidal breathing as ventilation increases. On exercise ventilation generally increases in the early phases by increasing tidal volume. Some patients will adopt a rapid shallow breathing response, others deep and slow, and some a combination of both. It is generally diagnosed through a visual inspection of the 9-panel of the exercise test.