The Interaction Between Asthma, Emotions, and Expectations in the Time of COVID-19

Figures & data

Table 1 Semi-Structure Interview Schedule

Semi-Structure Interview Guide
1. How is this period going?
2. How were the previous months when the situation was more drastic (ie during the first lockdown)?
3. I imagine that during this period you have repeatedly sought information about the virus and followed the news about the progress of the epidemic. Which source were you most satisfied with?
4. In your opinion, what are the chances of contracting Covid-19 in the coming months if you do not take the right preventive measures?
5. In your opinion, does Covid-19 have a different impact on asthmatic and non-asthmatic people?
6. In your opinion, does being an asthmatic put you at greater risk of contracting Covid-19 than non-asthmatic people of your age?
7. Faced with the possibility of contracting Covid-19 in the coming months, what are your prevailing emotions?
8. In your opinion, how much the preventive measures taken during this period (eg social distancing, masks, gloves, hand hygiene, etc.) are adequate in preventing and controlling the infection?
Possible prompts: 8.1. In your case, which preventive measures did you find most difficult to adopt? 8.2. In the coming months, when the restrictive measures will no longer be so strict, do you think you will continue to wear protective equipment and adopt cautious behaviour even if not explicitly requested?
9. What is your perception of your ability to cope sufficiently effectively and calmly with the current and future situation?
Possible prompts: 9.1. Do you feel confident enough or do you think that the difficulties will be too great/too heavy?
10. Have you been able to have a check-up with your doctor during this period as planned?
Possible prompts: 10.1. How did this situation make you feel?
11. During this period, did you feel the need to contact your doctor for further information and clarification about Covid-19?
12. During this time, how has the way you manage your illness changed?

Table 2 Participants’ Socio-Demographic Characteristics, Lifestyle, and COVID-19

Variables		N(%)	M(SD)
Total (N)		31 (100%)
Age (M, SD)			58.2 (16.2)
Gender (n, %)	Men	9 (29%)
	Women	22 (71%)
Marital Status (n, %)	Married	17 (56.7%)
	Divorced	0
	Separated	2 (6.7%)
	Single	6 (20%)
	Widower	4 (13.3%)
	Other	1 (3.3%)
Education (n, %)	Primary School	0
	Secondary School	3 (9.7%)
	High School	12 (38.7%)
	Bachelor’s degree	15 (48.4%)
	Master’s degree	1 (3.2%)
	Other Specialisations (eg, PhD)	0
Profession/job (n, %)	Employee	5 (16.1%)
	Self-employed	3 (9.7%)
	Unemployed	1 (3.2%)
	Students	0
	Retired	12 (38.7%)
	Teacher	3 (9.7%)
	Other	8 (24.8%)
Smoke	Yes	2 (6.45%)
	No	20 (64.5%)
	Ex	8 (25.8%)
	No answer	1 (3.2%)
Physical Activity	Yes	19 (61.3%)
	No	11 (35.5%)
	Ex	1 (3.2%)
Frequency of physical activity	Always	5 (16.1%)
	Often (2 or 3 times/week)	10 (32.25%)
	Sometimes (1 time/week)	3 (9.7%)
	Never	13 (41.9%)
Kind of physical activity	Hiking	3 (9.7%)
	Swimming	1 (3.2%)
	Running	2 (6.45%)
	Cycling	2 (6.45%)
	Yoga	1 (3.2%)
	More than 1 kind of activity	9 (29%)
Contracted COVID-19 (n, %)	Yes, proven by swab/serology positive	0
	I think so (compatible symptoms, but no swab/serology)	0
	No	31 (100%)
How severe was the COVID-19 (n, %)	I have been admitted to a clinical facility	0
	I have had symptoms comparable to flu	0
	I had very mild symptoms	0
	I did not have any symptoms	0
	I had no symptoms	0
Relatives who have contracted COVID-19	Yes	2 (6.4%)
	No	27 (87%)
	No answer	2 (6.4%)
Have you ever had a serious reaction after receiving a vaccine (n, %)	Yes	0
	No	31 (100%)
Do you suffer from heart or lung disease, asthma, kidney disease, diabetes, anaemia or other blood disorders? (n, %)	Yes	4 (12.9%)
	No	27 (87%)
Do you have a compromised immune system? (Example: cancer, leukaemia, lymphoma, HIV/AIDS, transplant)? (n, %)	Yes	0
	No	0

Abbreviations: M, Mean; SD, Standard Deviation; N, Number.

Table 3 Information on the Clinical Status of Participants

Variables		N(%)	M (SD)
Pulmonary function parameters (M, SD)
FVC (M, SD)			21.84 (9.7)
FVC% (M, SD)			91.03 (1.5)
FEV1 (M, SD)			17.23 (0.04)
FEV1% (M, SD)			86.68 (1.7)
TIF% (M, SD)			91.57 (7.3)
Severity of Asthma (N, %)
	Mild Persistent Asthma	17 (58.8)
	Moderate Persistent Asthma	14 (45.2)
Type of Asthma (N, %)
	Extrinsic Asthma	20 (64.5)
	Intrinsic Asthma	11 (35.5)
Most common allergies (N, %)
	Pollen	3 (9.7)
	Mugwort	7 (22.6)
	Mites	9 (29)
	Grasses	2 (6.4)
	Cypress	5 (16.1)
	Ragweed	2 (6.4)
	Dog	5 (16.1)
	Cat	2 (6.4)
	Other plants	3 (9.7)
Pet at home (N,%)
	Yes	7 (22.6)
	No	11 (35.5)
	In the past	13 (41.9)
Comorbidities (N, %)
	Bronchiectasis	3 (9.7)
	Hypertension	3 (9.7)
	Hypotension	1 (3.22)
	Glaucoma	2 (6.4)
	Gastroesophageal reflux	2 (6.4)
	Rhinitis/Oculorinitis	2 (6.4)
	Turban hypertrophy	2 (6.4)
	Nasal polyposis	2 (6.4)
	Otosclerosis in bilateral hearing loss	1 (3.22)
	Mitral insufficiency	1 (3.22)
	Nothing to report	12 (38.7)
Medications (N, %)
	Inhaled Corticosteroids (ICS)	16 (51.6)
	Long-Acting Beta-Agonists (LABAs)	3 (9.7)
	Leukotriene Modifiers	10 (32.2)
	Long-Acting Muscarinic Antagonists (LAMAs) or anticholinergic bronchodilators	4 (12.9)
	Desloratadine for Allergy Control	5 (16.1)

Abbreviations: M, Mean; SD, Standard Deviation; N, Number; FVC, Forced Vital Capacity; FVC%, Percentage of Forced Vital Capacity; FEV₁, Forced Expiratory Volume in the 1st second; FEV1%, Percentage of Forced Expiratory Volume in the 1st second; TIF%, Percentage of Tiffeneau-Pinelli index.

Figure 1 The referral and percentage of superordinate themes, themes and sub-themes in this dataset.

Table 4 Examples of Quotes of People with Asthma According to the Superordinate Themes, Themes and Sub-Themes Emerged

Superordinate Themes	Themes	Sub-Themes	Examples of Quotes
Illness	Symptoms of asthma	How is going	≪Well, I would not even know what to say to her because we have always been at home. Eh. I do not know. I am starting to go out now but always with the right caution, that is≫ (Patient AS50)
		Changes	≪Honestly. Yes, I have had some problems with asthma, I have been using sprays a bit more because maybe being confined indoors all the time could give me a moment of claustrophobia. a moment that was not 100% perfect….≫ (Patient AC47)
	Difficulties related to Covid-19	Difficulties related to the usage of DPI	≪Well, the only thing that bothers me a bit is wearing the mask because it takes the air out of me. Especially now that it’s starting to get a bit warmer, keeping the mask on gives me a feeling of suffocation≫ (Patient AS70)
		Difficulties related to obtain DPI	≪Perhaps the issue at the beginning was finding the gloves, which unfortunately was quite difficult≫ (Patient AC47)
		Missed activities	≪.the only thing I miss is being able to go out, walk around, take the baby around, you know…≫ (Patient ARD57)
		Information	≪I have never placed too much trust in television news and programmes because, as with everything, in my opinion, they have distorted reality to a great extent... in short, they convey misleading, distorted messages. And this, unfortunately, has contributed to the bad behaviour of people and also to generate fear... not that fear should not be linked to all this, but I am talking about a wrong fear... of panic. So, television I have always looked at it with scepticism. I have often followed the data and news from the Protezione Civile or other certified sites and bodies by searching the web. I have always found them very reliable≫ (Patient EG84)
Experienced emotions	Lockdown period	During lockdown	≪being housebound all the time could give me claustrophobia…≫ (Patient AC47)
		After lockdown	≪I do not go out much, I go around my neighbourhood and once a week I started going shopping again. Afterwards, when I was able to go out in May, I was a bit scared of going shopping, going to church, going by car. In short, all the things I had not done for a while≫. (Patient AG48)
	Medical changes	Related to canceled visits	≪I was a bit worried, yes I was a bit worried. But, I repeat, the fact that I felt quite well, that I did not need to take the drugs they told me to take in case there was a flare-up, then I felt quite. I did not feel bad, so there was no point in worrying.≫ (Patient AMB38)
		Related to obtained visits	≪But look, honestly, just by seeing me and talking to me she told me that she saw me very well because a few months ago I had gone and, even before visiting me, she had understood that there were problems. So I am very sure about that≫. (Patient AC47)
	Emotions Covid-19 related		≪Well, definitely a lot of fear still. Even if not as much as I was at the beginning, there are now, for better or worse, a few more weapons to fight it, there’s a bit more information from the medical point of view, so I would certainly be afraid as I still am, but it’s no longer the fear of emptiness, the fear of the unknown. It is the fear of a virus which is very powerful, but which is at least partially known. We have a few more weapons, so.≫ (Patient CP78)
Beliefs	Beliefs about asthma	Self-efficacy	≪In this situation I was at home for two months and I did not get exhausted or anything, I was quite serene... serene but not for what was outside, at home I was serene, that’s it, I was not bad in these two months≫. (Patient MS55)
		Worries and coping strategies	≪I was getting nervous for nothing since I cannot do anything about it. So I stopped watching all the news like I did before, like I did in the first week... now I do not really remember≫ (Patient AG48)
	Beliefs about Covid-19	Preventive measures	≪If it’s in the air, we catch it even without a mask. How do you know? I have never worn gloves because I have always been against it because they said it could make the situation worse if contaminated. So I have never worn gloves but I have a mask. But, in my opinion, if it’s a virus that you catch in the air and if you are on the terrace at home you catch it, in the end you do not know where it comes from.≫ (Patient MP75)
Expectations	Expectations related to Asthma	The combination of asthma and Covid-19	≪Eh. Well, it has a greater impact. Well, if it affects the lungs and bronchi, my lungs are already narrower. So it has a greater impact in the sense that. In fact, I was saying that they will not cure me even if I take it. You know the terrible news that they were telling us. Of course they have to decide whether there are enough ventilators. In fact, I was saying that I am like that and I am old enough that they will not even treat me. That’s it≫ (Patient LT37)
		Progression related to ageing	≪In my opinion, the same. In my opinion but I do not know if it’s scientifically correct but I see it catching young people also, anyone. Catching it can happen to anyone≫ (Patient MQ53)
		Progression in case of Covid-19	≪For me? Certainly the chances of contracting it are very high. Yes, high…≫ (Patient IG72)
	Expectations related to Covid-19	To contract Covid-19	≪Obviously I got the impression that the temperature has something to do with it anyway, it must be something that works a bit like the flu virus. So it’s very low right now, what’s going to happen in October I have not the faintest idea... if you look inside a glass ball, you are more likely to get it right. I have no idea, they have no idea, let alone me.≫ (Patient MM70)
		To use DPI in the future	≪So, I think I will continue, but we will all be more careful, like always washing our hands, if we are near someone you do not know, keep a little distance. Maybe the mask. If everyone does not wear it, there’s no point in me wearing it. But I dare say that even the mask, in certain environments like this, will remain there. It will certainly stay with me≫ (Patient MV63)
Behaviours	To protect	Protecting myself	≪I can assure you that I am following all the directives, even those on bikes that say you should not use the mask... but I use it anyway, so. Then I do not know what could happen, honestly, I do everything I can to make sure it does not happen, but then again.≫ (Patient MS55)
		Protecting the others	≪At the beginning it was a little bit distressing, a little bit worrying for everything and for the whole family, for the situation we were in.But we locked ourselves in the house≫ (Patient OF50)
	Risk taken		≪You try to do it, but sometimes it’s not possible. For example, I took the plane and the plane was full, all the seats were occupied. There was no social distancing whatsoever. We were all wearing masks but there was zero social distancing. They opened the doors and everybody piled on top of each other in the aisle... that’s a moment when the chances of contagion go through the roof, it’s useless to tell each other≫ (Patient OC79)
	Adherence	Adherence to therapy during lockdown	≪I continue with the treatments that have been prescribed. I know it’s something I will carry with me since I was born, it’s a habit in the end≫ (Patient AS70)
		Adherence to prescription related to Covid-19	≪I am about as by-The-book as you can get. And wash your hands, and do that, you know... everything... Even now that I am talking to you, I have it because I am on the road≫ (Patient MS55)
	Contacts with GPs	Contact for information	≪No, it was enough for me to get the information I was looking for on the Internet and from acquaintances who were more informed and knowledgeable about the subject than I was≫ (Patient EG84)
		Contact for Covid-19 issues	≪The doctor in charge does not want you there, they tell you to contact them only when there is a need... The medicines and these things here. You cannot waste their time because they have their own commitments. If there’s no good reason, I will not make phone calls≫ (Patient AS50)
		Contact for Asthma issues/visits	≪I made a phone call on the subject to the doctor... to my attending physician. Yes, when the situation first came out I wanted to ask anyway. I also sent an e-mail to the pneumologist at XX, who unfortunately, poor thing, contracted the virus and was therefore at home for a long period... I asked her for advice and also my doctor.≫ (Patient SI 79)
	Support	Receiving support	≪Well, my daughter helped me a lot because I have a disabled husband in a wheelchair, just to be lifted. So my daughter, when she stopped working at the end of March, she moved in with us because no more women came to our house. Nobody comes in anymore. So she moved in, although for the first fortnight she was quite far away, like in quarantine, just in case. But we had this big physical and psychological hand.≫ (Patient AG48)
		Giving support	≪In the afternoon my daughter would come because we live opposite... my daughter would come in the afternoon, I would make food for her and give her something good≫ (Patient LT37)

Table 5 Distribution of Themes and Sub-Themes in Relation to the Type of Asthma

Superordinate Themes	Themes	Sub-Themes	Extrinsic Asthma (N, %)	Extrinsic Asthma (References)	Intrinsic Asthma (N, %)	Intrinsic Asthma (References)
Illness	Symptoms of asthma	How is going	15 (48.4)	19	3 (9.7)	3
		Changes	13 (41.9)	16	4 (12.9)	6
	Difficulties related to Covid-19	Difficulties related to the usage of DPI	16 (51.6)	24	6 (19.3)	11
		Difficulties related to obtain DPI	11 (35.5)	15	2 (6.4)	2
		Missed activities	0	0	1 (3.2)	2
		Information	21 (67.7)	41	7 (22.6)	13
Experienced emotions	Lockdown period	During lockdown	16 (12.9)	34	5 (6.12)	13
		After lockdown	9 (29)	16	3 (9.7)	4
	Medical changes	Related to canceled visits	20 (64.5)	39	6 (19.3)	10
		Related to obtained visits	7 (22.6)	11	0	0
	Emotions Covid-19 related		22 (70.8)	38	5 (6.12)	12
Beliefs	Beliefs about asthma	Self-efficacy	12 (38.7)	8	5 (6.12)	5
		Worries and coping strategies	16 (51.6)	32	4 (12.9)	9
	Beliefs about Covid-19	Preventive measures	18 (58)	28	7 (22.6)	8
		Acceptance	2 (6.4)	2	0	0
		Related to contract Covid-19	20 (64.5)	29	7 (22.6)	8
Expectations	Expectations related to Asthma	The combination of asthma and Covid-19	22 (70.8)	52	7 (22.6)	13
		Progression related to ageing	15 (48.4)	15	7 (22.6)	11
		Progression in case of Covid-19	21 (67.7)	34	6 (19.3)	9
	Expectations related to Covid-19	To contract Covid-19	21 (67.7)	34	6 (19.3)	9
		To use DPI in the future	18 (58)	24	7 (22.6)	11
Behaviours	To protect	Protecting myself	16 (51.6)	36	4 (12.9)	7
		Protecting the others	8 (25.8)	26	2 (6.4)	4
	Risk taken		0	0	0	0
	Adherence	Adherence to therapy during lockdown	17 (54.3)	25	5 (6.1)	7
		Adherence to prescription related to Covid-19	14 (45.2)	15	4 (12.9)	5
	Contacts with GPs	Contact for information	16 (51.6)	42	6 (19.3)	12
		Contact for Covid-19 issues	22 (70.8)	30	4 (12.9)	4
		Contact for Asthma issues/visits	7 (22.6)	6	2 (6.4)	2
	Support	Receiving support	4 (12.9)	7	1 (3.2)	3
		Giving support	3 (9.7)	3	1 (3.2)	1

Notes: The number of participants who referred to the theme and the number of references to each theme for each type of asthma are considered, in separate columns.

Figure 2 Co-occurrences about the presence of fear.

Figure 3 Co-occurrences about beliefs associated with mask.

Figure 4 Co-occurrences about beliefs associated with gloves.