Breathlessness Perceptions Within Respiratory Diseases

Optoelectronic plethysmography allows to quantify how different thoracic compartments contribute to the overall tidal volume through regional contribution parameters. These regional contributions are expressed as percentages.

The duration will be recorded in minutes and seconds to state how long a specific measurement lasted.

This is one of the core timing parameter. The system uses sample at 60-120 Hz (frames per second).

This parameter is important to give an indication of data adequacy. It will be reported in whole numbers.

All the parameters will be expressed as percentages. (%RCp, %RCa and %AB) typically ranging from (0-100%)

These parameters will be meausred by the degree ranging from 0 to 180 (Complete paradox)

This will be reported in decimal values. (Ti/Ttot, Ti/Te ratio, IE ratio inverse of Ti/Te) Ti-Inspiratory time Te-Expiratory time Ttot-Total breath duration

Provides details about how breathlessness one feels and how hard the exercise is during exercise . Both these scales will be reported in numbers. The RPE is from 6-20 and the Borg scale is from 0-10. Higher scores will indicate worst breathlessness and exertion from the performing exercise.

Lung Function parameters such as FEV1 -Forced Expiratory Volume, FVC -Forced Vital Capacity, FEV1/FVC ratio will be obtained using Spirometry (Spirotrac). Presented in litres can be converted to percentage. Depending on the guidelines usually if the FEV1/ FVC ratio<= 0.7 it can be said that there is an airway obstruction. Lower value indicates a higher level of breathlessness. The GOLD classification criteria is usually used to describe the severity. The values can further be explained as obstructive or restrictive by looking at the FVC%. A lower FVC% predicted will indicate worse restriction.

Scale that grades the severity of breathlessness based on the level of physical activity that provokes the symptom. The scale is from 0-4. Lower values indicate less severity of breathlessness while higher values indicate severe breathlessness.

The Dyspnoea-12 (D-12) is a patient-reported outcome measure designed to assess the multidimensional nature of breathlessness severity through both physical and affective components. The questionnaire has 12 questions where the participant will be asked to put a tick to any box from none, mild, moderate and severe.

Self-report questionnaire designed to screen for clinically significant anxiety and depression in medical populations. The participant will be asked to underline their answers for all the questions. The questionnaire includes a 'A' category and a 'D' category. Scores are given to both catergories from 0-3. At the end the two catergoeies will be calculated separately.

A measure designed to assess catastrophic thinking patterns specifically related to breathlessness. BCS is a 13 item questionnaire where the participant will have to tick one of the boxes for each question starting from not at all, to a slight degree, to a moderate degree, to a great degree and all the time.

A standardised generic health-related quality of life instrument designed to provide a simple, comprehensive measure of health status across diverse populations and conditions. The questionnaire asseses 4 sections where the participant will have to select one option from each section. The questionnaire is assessing the health related quality of life interms of that day and not in general. At the end of the questionnaire there is a separate scale from 0-100 where the participant will have to place an x mark on the scale and write that score in a box which will indicate how they feel on that specific day.

An instrument designed to assess symptoms associated with hyperventilation syndrome and dysfunctional breathing patterns. The questionnaire contains 16 symptoms. The participant will be required to place a tick in one of the boxes for each question. Answers include, never, rarely, sometimes, often and very often.

Visible characteristics of breathing patterns during rest where the participant will be asked to rest against a back seat. The participant will be observed for 1 minute by a member of the study team where they will have to breathe in and out as they usually do. During that time the team member will observe whether the breathing is rhythmical, whether the participant is using using their chest, abdomen or both for breathing, whether their inspiratory and expiratory flows are silent, audible or loud. Other questrions that will be answered by the team member would be channel of inspiration and expiration, air hunger, rhythm as well the team member will also calculate the respiratory rate within a 1 minute. Scores will be given from 0-2 and at the end the total score will be calculated.

Peak Oxygen Uptake (VO2 peak) meausured through mL/min or L/min, If >=85 is normal, 65-84 is mildly reduced, 50-64 is moderately reduced and <50 is severely reduced.

Carbon Dioxide Output (VCO2) and RER (VCO2/VO2) meausured through mL/min or L/min, VCO2 roughly rises parallel to VO2. The volume of CO₂ produced per minute by the body reflects the metabolic CO₂ production from aerobic and anaerobic metabolism combined. The respiratory exchange ratio which is RER gives a clear indication whether the test was maximal effort or not.

RER >=1.10 is the key cutoff.

AT will all be meausured through mL/min or L/min. Normal: typically > 40% of predicted VO₂ max, or ≥ 11 ml/kg/min Higher AT = better - indicates the body can sustain aerobic metabolism at higher workloads before switching to anaerobic system.

Minute Ventilation will be measured at maximal exercise. The measures will be stated in L/min. Minute ventilation is assess the ventilatory capacity. Usually the ventilatory reserve utilizes <60 to 70% of the maximum voluntary ventilation which is considered healthy.

Tidal Volume will be measured by L or mL. It is amount of air that moves in and out of the lung. During exercise, it increases linearly before plateauing indicating whether a participant's exercise capacity is physically restricted due to lung mechanics.

This is measured by breaths per minute. The amount of breaths taken will indicate how your brain and lungs are functioning to clear the carbondioxide which will help to maintain the chemical balance.

Resting phase 12 to 20 breaths/min -Baseline range Peak Exercise 35 to 45 breaths/min -Normal physiological range for healthy adults.

MVV- Maximal Voluntary Ventilation and BR-Breathing Reserve both are measured by L/min. This determines whether a patient's exercise capacity is limited by their lungs or by their heart and/or muscles. MVV represents a participants absolute ceiling for breathing capacity, while BR measures how much of that capacity is left over at peak exercise. If MVV >=80% it is considered good and if <80% it is considered bad. Whereas for BR, if >11L/min is considered as the lungs still having more capacity left after exercising and <=11L/min is considered that the patient is exhausted and their breathing capacity has reached the limit.

VE/VO2 slope and VE/VCO2 at AT are measured by a dimensionless ratio. VE/VCO2 is considered good when it is between 23-30 and bad when it is >34. VE/VO2 is considered good when it is between 25 to 33 and bad when it is >36

This will be measured through bpm. It is the difference between predicted maximum heart rate and the actual peak heart rate. <15bpm indicates a good response whereas >=15bpm indicates a poor response.

This will be reported in W (Watts). Achieving >= 80% of the predicted work rate is considered a good response whereas <80% would be considered as a poor response.

This will be reported through % (Percentage). 95-100%- Good 93-94%- Borderline <92%- Bad

This will be measured by mmHg Before the test (At rest) >=200/110- Contraindication not to perform the exercise test <90/60- Too low for the baseline

During the exercise test, If the systolic value exceeds 190 or 210 indicates a severe hypertension A critical stop would be a systolic value exceeding 250 or a diastolic value exceeding 115.

After the test, The blood pressure should return to near or actual borderline taken during rest.

Measured through cm.

Measured by kg (Kilograms).

Calculated manually via height and weight measurements. Will be presented as kgm squared. This study has a cut off value which is not involving participants above 35.

SDNN- Standard Deviation of normal-to-normal R-R intervals, SDANN-Standard Deviation of the mean R-R intervals, RMSSD-Square root of the mean squared difference of successive R-R intervals are all measued by milliseconds (ms).

LF-Low Frequency Power and HF-High Frequency Power are both measured by milliseconds squared or absolute units.

LF Absolute 300 to 1500- considered good LF Absolute <100 -considered bad/abnormal

HF Absolute 200 to 1000- considered good HF Absolute <50- considered bad/abnormal

LF/HF ratio will be a dimensionless ratio represented without any units. High rates will suggest of sympathetic predominance.

At rest Good range will be 1.0-2.0 Bad range >5 or <0.5