Breathlessness, also known as dyspnoea, is a common presenting complaint in the outpatient family physician clinic. It is most commonly caused by respiratory and cardiac disorders, but there are lots of other important aetiologies that need to be considered. The initial goal of assessment is to determine the severity of the dyspnoea, considering the need for oxygen therapy and intubation. Unstable patients usually present with abnormal vital signs, hypoxia, diaphoresis, and/or altered mental states, and require urgent management. Ongoing care depends on the differential diagnosis established by an adequate history and physical examination, and investigations, if available, can aid definitive diagnosis. The family physicians must be equipped to initiate appropriate therapy, conduct continuous monitoring and stabilise an acutely dyspnoeic patient before determining the final disposition of the patient.