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Background: The current state-of-the-art in Non-Invasive Ventilation (NIV) focuses on identifying predictors of NIV failure, yet modest attention has been given to NIV adherence, which is crucial for successful outcomes, highlighting the need for standardized instruments to assess adherence and close monitoring to prevent delays in intubation. Aims: The main aim of this study was to validate the Belief about Ventilation Questionnaire (BVQ), developed to screen for potential adherence to NIV and the related beliefs. Methods: The themes that emerged from the qualitative interviews with respiratory disease patients' statements, supplemented with scientific literature and clinical experience, were used to develop the content of the questionnaire. After completing a pilot phase, the questionnaire was distributed to 399 individuals (mean age=69.7; SD=13.1) diagnosed with obstructive or restrictive respiratory diseases and recruited at IRCCS Fondazione Don Carlo Gnocchi, in Milan (Italy). Structured equation models and factor analysis were used to analyse the data that were gathered. Results: The Confirmatory Factor Analysis (CFA) demostrated good convergent validity, and acceptable test-retest reliability. Internal consistency, as measured by Cronbach’s alpha, exceeded the threshold of 0.725, indicating good reliability. Model fits were ascertained using two fit indexes such as Root Mean Square Error of Approximation (RMSEA) and Comparative Fix Index (CFI). Conclusions: The BVQ can represent a valuable tool to assess beliefs and adherence to NIV. It is expected to be validated also in English, French, Spanish and German.

Background: Despite effective inhalation therapy, uncontrolled asthma remains prevalent. Narrative Medicine (NM) seeks to understand illness experiences linguistically, providing a framework to enhance healthcare. Aims: To gather narratives from uncontrolled asthma patients and Health Care Professionals (HCPs), exploring treatment decisions, adherence factors, emotions, economic burdens, and comprehensive care. Methods: A cross-sectional NM study was conducted in Italy (February-December 2023), involving 135 uncontrolled asthma patients [54.7% male; mean age:56.7 years] and 47 HCPs [64.9% male; mean age: 54.3 years]. A mixed-method approach was adopted to examine themes, language, emotions, and narrative classifications. Results: The patients reported an average illness duration of 4.46 years, with worsening occurring over the last 20.9 months. Pulmonologists (83% of HCPs) took a primary role in diagnosing and treating the disease in 96.1% of patients. Additionally, 51 patients reported incurring extra costs in the treatment of their asthma. The most frequent reported feelings were tiredness (25.96%) and feeling suffocated (11.53%). Once they started treatment, although feeling better physically, they mostly experience emotion of "submission/dependence" on the drug (28%), followed by "fear" (21%) and "serenity/joy" (21%). The HCPs, mainly pulmonologists (83%), emphasized the need for increased specialist and general practitioner awareness, including information dissemination, attention to prescriptions, phenotyping, targeted therapy, and paediatric considerations. Conclusions: The findings enhance patient understanding, personalize interventions, and highlight factors influencing therapeutic adherence.

Background: Obstructive Sleep Apnea (OSA) impacts couple relationship quality between patients and bedpartners. Although Continuous Positive Airway Pressure (CPAP) is recognized as the gold standard treatment, adherence to it poses significant challenges, potentially influenced by illness perceptions (IP). Aims and Objectives: This study aims to investigate the association between CPAP adherence, patients' and bedpartners' IP, and couple relationship quality. Methods: A cross-sectional study is currently underway at the Sleep Center of Fondazione Don Gnocchi (Milan), involving OSA patient-bedpartner dyads, who completed medical and psychological assessments including questionnaires on IP, daytime sleepiness, sleep quality, and relationship quality. Results: The study involved 65 couples with OSA (average AHI=31.20). Patients, remotely monitored (CPAP hours/night: 4.64±2.55), were categorized based on CPAP adaptation stages: 12.3% not yet started, 43.1% within the first year, and 44.6% over a year. Patients' IP of severity decreased with longer adaptation [(t(62)=-2.52, p=.007], with similar trends in bedpartners [(t(62)=-1.71, p=.046]. A negative correlation was found between CPAP usage and patients’ IP (r=-.381; p=.004). However, a positive correlation was noted between patients' and bedpartners' IPs (r=.453; p=.001). Relationship quality improved with longer CPAP adaptation, in both patients [(t(60)=2.19, p=.016] and bedpartners [(t(52)= 2.67, p=.005], but was not significantly correlated with its usage. Conclusions: Considering IP in interventions to enhance CPAP adherence is crucial in OSA management.

Introduction: The practice of mindfulness, formalised in the structuring of well-known protocols such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT), have proven to be very effective in reducing stress related to chronic conditions (Cherkin et al., 2016; Johns et al., 2015) and of depression (Hilton et al, 2017; Schumer, Lindsay, & David Creswell, 2018). However, these protocols generally require a high level of engagement for participants, which is why, in the present exploratory study, we opted to evaluate the implementation of a shor and less intensive Mindfulness-based protocol, but which showed good results on health-related outcomes, even with a single session (Howarth, Smith, Perkins-Porras, & Ussher, 2019). The overall objective of this exploratory study was to develop and evaluate the implementation of a short-term, Mindfulness-based intervention conducted in telemedicine, compared with usual care alone, on the symptoms associated with Post Traumatic Stress Disorder Stress Disorder (PTSD) of persons who have previously tested positive for COVID-19, admitted to a resuscitation and/or intensive care unit and then in pulmonary rehabilitation following negativization. Methods: The present pilot randomised controlled trial compared the impact of a Mindfulness-based brief intervention conducted in telemedicine (n = 20) for a period of 5-6 sessions of 45 minutes each, for a total commitment of 3 weeks, to a wait-list control (n = 20), involving people who have been previously tested positive for COVID-19, admitted to intensive care or reanimation and subsequently in respiratory rehabilitation following negativization. The General Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Impact of Event Scale (IES), Perceived Stress Scale (PSS), State Shame and Guilt Scale-8, Peritraumatic Perceptions of Fear and life threat, Psychological General Wellbeing Index (PGWBI), respiratory functions, oxygen satur

Valentina Poletti,1 Francesco Pagnini,1 Paolo Banfi,2 Eleonora Volpato1,2 1Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy; 2IRCCS Fondazione Don Gnocchi, Milan, ItalyCorrespondence: Valentina Poletti, Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy, Email valentina.poletti@unicatt.itBackground: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation. Besides its irreversibility, COPD is a treatable condition, and patients would strongly benefit from being adherent to their treatments. However, almost half of them are non-adherent, and, according to several recent studies, the way the patient perceives the disease might influence this variable.Aim: This systematic review provided a synthesis of studies about the relationships between illness perceptions (IP), cognitions, beliefs, and adherence in COPD.Methods: English language publications were searched in PubMed, Medline, Scopus, ResearchGate, PsycINFO, and Cochrane Library databases from November 2022 to February 2023, following PRISMA guidelines. The reference lists of eligible studies were also searched. Data extraction and critical appraisal were undertaken by two reviewers working independently.Results: A total of 14 studies were included. Adherence to treatment in COPD is confirmed to be low, using both self-report questionnaires and objective assessment systems. Most studies concluded that COPD is perceived as a moderate threat destined to last forever, even if many participants referred to little disease knowledge. This perception did not change between adherent and non-adherent groups. Those who considered more necessary to take their medicines and had a caregiver were more adherent and less concerned about their future. On the other side, forgetfulness, lack of trust in medications, and difficulties in understanding how to take them were perceived

Introduction: The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19. Methods: Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis. Results: Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants’ narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring. Discussion: The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.

Background: Using Non-Invasive Ventilation (NIV) in an acute setting for COVID-19-related acute hypoxic respiratory failure (AHRF) can be a stressful and anxiety-inducing experience for patients in the Respiratory and Intensive Care Units (RICU and ICU). Aims and objectives: This study aimed to investigate the presence of anxiety, symptoms related to Post Traumatic Stress Disorder (PTSD), psychological distress, and depression about the perception of one's disease state in people with COVID-19-related AHRF undergoing NIV during their stay at RICU/ICU and after rehabilitation. Methods: Fifty-two people with COVID-19 (M=66.9; SD=9.17) were evaluated during hospitalization in the RICU/ICU, and at 6 months, after rehabilitation, for symptoms of anxiety, psychological distress, Post Traumatic Stress Disorder (PTSD), and depression, in relation to the perceived severity of illness and NIV’s usage. Results: Patients with COVID-19 experienced increased fear and anxiety due to the severity of their illness and the uncertainty surrounding the disease in the acute setting. The need for NIV indicated more severe COVID-19 disease, which significantly increased fear and anxiety [(t(14)= 2.79, p=.014] compared to the remission period, leading to feelings of loss of control and a decreased psychological well-being [(t(17)= 2.35, p=.031]. Resilience significantly improved over time [(t(16)= -4.78, p<.001]. Conclusions: Healthcare professionals need to supply more attention and support, such as offering reassurance, providing information, and addressing any concerns or fears.

Background: Patients with Chronic Obstructive Pulmonary Disease (COPD) who received supplemental oxygen reported improved symptoms such as increased energy, less breathlessness, and improved quality of life, even though the oxygen therapy was not actually providing any additional therapeutic benefit beyond maintaining adequate oxygen levels. Aims and objectives: To investigate the impact of the placebo effect on oxygen therapy during the 6-Minute Walking Test (6MWT) in patients with COPD. Methods: A randomized crossover two-arm study was conducted with 95 patients with COPD (68.4% male, average age 67). All participants underwent baseline assessments, including the Mini-Mental Status Examination, the Modified British Medical Research Council Questionnaire, the Fatigue Severity Scale, and Simple Spirometry. All participants underwent 6MWT, using one medical oxygen (O2) concentrator and another whose molecular filters (MF) had been removed, so patients believed the concentrator was delivering oxygen. The sequence of the first group was ABC (A = Baseline, B =MF, C = O2), while the sequence of the second was ACB. Saturation, heart rate and blood pressure were measured at baseline, at 3’:30’’ and after 6MWT. Results: A repeated measures ANOVA was performed to compare the effect of oxygen usage on the 6MWT. There was no statistically significant difference in the 6MWT between the two groups (F(2, 1) = 0.113, p = 0.888). Conclusions: Although the use of oxygen remains an important and effective treatment for maintaining adequate oxygen levels, specific treatments based on beliefs and patients' expectations can improve the healthcare process in COPD.

Eleonora Volpato,1,2 Paolo Banfi,2 Francesco Pagnini1,3 1Department of Psychology, Universita’ Cattolica del Sacro Cuore, Milan, Italy; 2IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 3Department of Psychology, Harvard University, Cambridge, MA, USACorrespondence: Eleonora Volpato, Department of Psychology, Università Cattolica Del Sacro Cuore, Via Nirone, 15 CAP. 20123, Milan, Italy, Email eleonora.volpato@unicatt.itIntroduction: The main aim was to gain insight into the experience of adult people with a diagnosis of at least 6-months of mild or moderate persistent asthma according to the Global Initiative for Asthma (GINA), and their emotions, beliefs, and expectations during the first wave of COVID-19.Methods: Qualitative semi-structured interviews using the Interpretative Phenomenological Analysis (IPA) were carried out by phone involving 31 people (mean age=58.2; SD=16.2). Interviews were audio recording, transcribed verbatim and analysed through thematic analysis.Results: Five superordinate themes and themes were dedicated to illness (symptoms of asthma; difficulties related to COVID-19), experienced emotions (lockdown period; medical changes; emotions COVID-19 related), beliefs (about asthma; about COVID-19), expectations (related to asthma; related to COVID-19) and behaviours (to protect; risk taken; adherence; contacts with General Practitioners; support). The prevalence of emotions such as fear, worry and anxiety emerged in the participants’ narratives. All are accompanied by a preference for action and problem solving. A sense of protection, connection to self and other, and commitment to life were revealed as central concepts for enhancing well-being even at a time of deterring.Discussion: The common threads of the presence of uncertainty and vulnerability open the outlook of a treatment that ensures greater continuity and ownership of care in the patient, preserving the sense of self-efficacy even in times of greater instability.Keywords: asthma

Background: The management of tracheotomy at home can be very complex, affecting the patient's quality of life. Objectives: This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. Methods: Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. Results: 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. Conclusions: The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.

Non-invasive ventilatory support (NVS) is a technique used to reduce respiratory work in neuromuscular diseases, preventing the progression of respiratory failure. NVS is usually administered via a nasal or an oronasal mask, causing discomfort, especially in patients ventilated for more than 16 h/day. Intermittent abdominal pressure ventilation (IAPV) differs completely from conventional NVS and consists of a portable ventilator and a corset with Velcro closures as the interface. In our study, the practicability and efficacy of IAPV were studied in three Italian centers monitoring 28 neuromuscular patients using IAPV who were then retrospectively analyzed. The primary outcomes were an improvement in hypoxemia and the normalization of hypercapnia, and the secondary outcome was an improvement in quality of life. Data were collected at baseline (T0) and after two hours of ventilation (T1), with follow-ups at three months (T2) and six months (T3). Statistical significance was found for PaCO2 over time (F (2.42) = 7.63, p = 0.001) and PaO2 (W = 0.539, p = 0.033). The time of NVS usage also significantly affected the quality of life (F (2.14) = 6.90, p = 0.010), as seen when comparing T0 and T3. As an alternative ventilation method, IAPV is still relevant today and could become a key part of daytime support, especially for patients who do not tolerate standard daytime NVS with an oral interface.

Lives of people who suffer from respiratory diseases, such as complex asthma, pulmonary fibrosis, Chronic Obstructive Pulmonary Disease (COPD), are disturbed by many different factors. In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in respiratory diseases and may affect the health care process as well as rehabilitation delivery and outcome. While the impact is unique for each individual, key areas of difficulty include fear of breathlessness, reduced activity levels, fatigue, lowered self-efficacy and energy, disrupted relationships, anxiety and significantly lowered mood. For many, the physical symptoms of breathlessness are exacerbated by anxiety and panic in a vicious cycle of escalating breathlessness, physiological arousal and further panic. The meaning of the lung condition for an individual can be informed by illness perceptions not necessarily supported by medical understanding, and thus misinterpretation of bodily sensations can fuel anxiety and fears. Finally, it is very complex to define the role of these factors in the management processes of medical therapies, as well as those requiring physical activity or the use of devices. This article collection aims to present the most recent advances in research on the psychological factors involved in the respiratory diseases, as well as their implications in the health management process.

Introduction: Non-Invasive Positive Pressure Ventilation (NPPV) is an established treatment for people with Chronic Obstructive Pulmonary Disease (COPD), but it is often improperly used or rejected. The patterns of acceptance and adherence to NPPV, conceiving constraints, and strengths related to its adaptation have not been explored from a qualitative perspective yet. Objectives: This study aims to qualitatively explore patterns of adaptation to NPPV in people affected by COPD and to identify the core characteristics and the specific adaptive challenges during the adaptation process. Methods: Forty-two people with moderate or severe COPD were recruited and 336 unstructured interviews were conducted. A Constructivist Grounded Theory was used to gather and analyze data: the transcriptions were mutually gathered in open, selective, and theoretical phases, with open, selective, and theoretical coding, respectively. Results: The analysis resulted in a non-linear and dynamic process, characterized by three phases: deciding, trying NPPV, and using NPPV. The patterns revealed that positive and negative NPPV experiences, together with beliefs, emotions, stressful mental states, and behaviors result in different acceptance and adherence rates. Discussions: These findings may be helpful to implement new care strategies to promote acceptance and adherence to NPPV.

Background: Caregivers of Amyotrophic Lateral Sclerosis (ALS) patients experience varying psychological responses following the patient's death, including sadness, loneliness, guilt, and a loss of purpose. Objectives: This research aims to investigate the caregiver journey experienced from the time of diagnosis to the loss of a care recipient, with a specific focus on understanding the factors that contribute to improved coping with bereavement. Methods: The present study used the Interpretative Phenomenological Approach (IPA) to qualitatively explore the accounts of 41 Italian bereaved caregivers of people affected by ALS (Mean Age = 59.78; Female: 60.98%; Male: 39.02%). Results: Results revealed 5 overarching themes representing 5 macro areas that emerged from the analysis of the interviews ("Caregiver's perception of his/her life", "Caregiver's feelings", "Caregiver's life after patient's death", "Caregiver's disease description", "Caregiver's help resources"), these were further defined based on 12 main themes, which were, in turn, articulated into 30 subthemes. The transition from life before ALS ("a peaceful landscape") to caregiver life (compared to the color "black") was a "shock", during which caregivers had to change their needs. However, life after the person living with ALS' death was both characterized by a sense of "re-birth" and "emptiness", and a general need for "psychological assistance" and "social support". Conclusions: Results emphasize the need to improve the psychological support offered to caregivers of person living with ALS after the patient's death, tailoring it to the specificity of the condition, to meet their emotional needs, reduce isolation and help them cope with practical challenges and plans.