Table 1 Results: Themes, description and quotes.

1. De-prioritisation of diagnosis by patients and healthcare.

“I ain’t getting any healthcare at the moment. You know, I won’t bother the doctors with this at the moment because they won’t, I suppose they can’t do a lot over the telephone. And I wouldn’t want to go doctors to be seen because I wouldn’t, there’s a risk of catching anything.”

Description: The COVID-19 pandemic has led to a reduction in this group seeking healthcare; either appointments or investigations cancelled or no onward referral.

Some described their breathlessness as a non- urgent problem and others felt worried about burdening their GP and the NHS at this time.

“Well, I was trying to just wait my turn sort of thing, I don’t really, they’re busy enough as it is aren’t they? If I cannot add to it, I won’t.”

“I mean really to get a phone call from the doctor now is like asking for a miracle really anyway, and then you’re just going to say well I need some advice on my breathing. It feels wrong to even do that you see.”

“…it’s inhibited me from going to see my GP to try and get kind of follow-up on what’s going on.”

“Yeah they just said they’ll contact me when it’s possible to start doing things again, you know, because it’s not an urgent thing.”

“So they phoned me… so she said… we’ll just leave it until the lockdown is finished.”

2. Following UK ‘lockdown’ guidance for the general population but fearful they are more at risk

“It feels like you’re being a bit of a bother for nothing, because I’ve not been actually diagnosed you see. We, who haven’t been diagnosed, are sort of out of the picture if you know what I mean, because we don’t get the letter for being vulnerable either… So we’re stuck.”

Description: This group were not identified as vulnerable and were following guidance for the general population. However, many describe a clear perception of being at increased risk if they were to contract COVID-19.

Not being included in an ‘at risk’ group caused increased anxiety and uncertainty.

“So and I suppose in a separate way it’s more of a concern to me that if I am asthmatic, you know, if I was to get the COVID-19, would I be more at risk.”

“General guidance, yes, that helps, but mostly for my health. I’m maybe a little bit frightened in case, I think if I got it I wouldn’t get over it because of my breathing. And yes when you can’t get your breath it is frightening, so I think that’s, obviously I don’t want to go just yet so.”

“Because I have said to my husband, if I get this, it’s going to be serious because I have problems breathing anyway.”

3. Impact of lockdown on coping strategies for managing breathlessness.

Engaged Coping:

“Yeah I’ve got a lady who comes on the tablet and she does yoga with me, tells me what to do. I do that twice a week.”

Description: People have expressed modified behaviour to learn new skills or change their routine to help them cope with lockdown. Some expressed not coping in the new environment.

The nature of lockdown and reduced activity and social interaction reinforces the negative cycle of physical inactivity often seen with breathlessness.

“But I also make time now for a short walk, either in the morning or in the afternoon, just around the block.”

“I mean like I said I’m doing exercises nearly every day and practising yoga and it’s just because I’m at home so I have time to do that. I don’t know what’s going to happen when I start work properly.”

Disengaged coping:

“It is very depressing not being able to go out anywhere. Even though I can’t walk

that far without getting out of breath, I could still visit people, you know… it’s just being indoors all the time.”

“Well since it’s been like it is, I’ve not been getting up very early and sometimes it’s, most days I don’t really want to get up. But, and sometimes I have to force myself.”

“Well, I’m stuck in with this isolation thing which is driving me mad... and I find the less you do, the less you can do. So I can’t even go in the garden or do the gardening. But, you know, I potter round the house, I feed myself, I do the washing and that.”