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Background Inducible laryngeal obstruction (ILO) and breathing pattern disorder (BPD) often co-exist with or are misdiagnosed as asthma.Aim To identify patients in the Manchester complex breathlessness service with suspected incorrect asthma diagnosis, and report subsequent change in healthcare utilisation, symptoms and medication use following nurse-led breathlessness management.Methods Clinical outcomes were collected over a 12-month period following initial assessment, including: asthma control questionnaire (ACQ-6), lung function, medication use and healthcare utilisation.Results Of 32 patients [30 female, median (IQR) 48 (41–58) yrs], 15 had ILO, 7 BPD and 10 both. 27 were treated with inhaled corticosteroids, and two with daily prednisolone. All had normal lung function and FeNO, and seven had a bronchial challenge (all negative). Pretreatment, median (range) 1 (0–22) ED attendances, 1 (0–7) admissions, 1 (0–12) steroid courses, 1 (0–10) antibiotic courses in previous 12 months and ACQ 2.15 (0–5.4). Patients had on average three follow-up visits with the clinical nurse specialist alongside input from speech and language therapy for ILO and physiotherapy for BPD where appropriate. Following intervention, there were significant improvements in hospital admissions, steroid/antibiotic courses and ACQ score (all p<0.05). 30 patients stopped their reliever completely, 18 their inhaled corticosteroids and none needed maintenance daily prednisolone.Conclusion Correct diagnosis and reduction of unnecessary pharmacotherapy in patients presenting with refractory breathlessness can reduce treatment burden, healthcare utilisation and improve symptoms.