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Background and objective Breathlessness is associated with higher rates of unplanned health service utilisation. We aimed to evaluate any associations between the severity of breathlessness limiting exertion (hereafter breathlessness), time between breathlessness recording and subsequent unplanned hospital admissions, and length of stay.Methods A retrospective cohort study of adults seen in general practice (UK Clinical Practice Research Datalink) with breathlessness (Medical Research Council (MRC) breathlessness scale; 1–5; 5 is most intense), no pre-existing cardio-respiratory disease and a subsequent unplanned hospital admission. Data from 2007 to 2017 were used. By intensity of breathlessness, time to first unplanned admission and hospital length of stay were evaluated, the latter using negative binomial regression.Results 103 917 adults had breathlessness scores recorded, of which 16 948 used MRC. 11 911 (70%) adults had a subsequent unplanned hospital admission (median (IQR) of 1538 days (846–2258)) later. More intense breathlessness was associated with higher age, higher body mass index and being a smoker/ex-smoker.Length of time between a first-recorded breathlessness score and the first unplanned hospital admission decreased significantly with higher MRC scores (MRC 1: 1167 days; MRC 5: 615 days).Negative binomial regression showed an association between higher MRC scores and an increased length of inpatient stay (p<0.001; Akaike information criterion=20 817), controlling for key demographic factors.Conclusion This is the first study to identify an association between recording breathlessness intensity and time to a person’s first unplanned hospital admission and longer inpatient length of stay. Future work must focus on whether interventions can change people’s health service use.