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Expected breathlessness is overestimated compared to experienced : a mobile ecological momentary assessment study

Sandberg, Jacob LU orcid ; Sundh, Josefin ; Anderberg, Peter LU ; Currow, David C and Ekström, Magnus LU orcid (2026) In ERJ open research 12(4).
Abstract

BACKGROUND AND OBJECTIVE: Chronic breathlessness is common and often leads to avoidance of symptom-provoking activities. Expectations of breathlessness influence behaviour and symptom perception, but the accuracy of these expectations remains unclear. The aim of this study was to examine the relationship between expected and experienced breathlessness, the moderating role of mental states, determinants of expectation accuracy and the influence of recent symptoms on future expectations.

METHODS: In this longitudinal study, 83 participants with chronic breathlessness rated expected and experienced breathlessness (on 0-10 numerical rating scales (NRS)) using a mobile ecological momentary assessment app over 7 days. Associations were... (More)

BACKGROUND AND OBJECTIVE: Chronic breathlessness is common and often leads to avoidance of symptom-provoking activities. Expectations of breathlessness influence behaviour and symptom perception, but the accuracy of these expectations remains unclear. The aim of this study was to examine the relationship between expected and experienced breathlessness, the moderating role of mental states, determinants of expectation accuracy and the influence of recent symptoms on future expectations.

METHODS: In this longitudinal study, 83 participants with chronic breathlessness rated expected and experienced breathlessness (on 0-10 numerical rating scales (NRS)) using a mobile ecological momentary assessment app over 7 days. Associations were analysed using linear and mixed regression models.

RESULTS: Expected breathlessness was significantly associated with subsequently experienced breathlessness (β=0.51, 95% CI 0.35-0.68) but was systematically overestimated (mean±sd expected 4.7±1.9
versus experienced 2.9±1.7; mean absolute difference 2.0±1.5). Depressive symptoms attenuated the association (β=0.40, 95% CI 0.23-0.58), whereas anxiety, wellbeing and self-efficacy were not associated with either the strength or the accuracy of expectations. Expected breathlessness for the upcoming week was strongly related to the experience during the study week (β=0.85, 95% CI 0.61-1.08, R
2=0.48), suggesting recent experience shapes expectations more than expectations predict future breathlessness.

CONCLUSION: Individuals with chronic breathlessness overestimated future breathlessness by a mean of 2 NRS points. Indication of depressive symptoms influenced the strength of the association, but accuracy appears unaffected by mental state indicators. These findings highlight the need to address and recalibrate symptom expectations in clinical care.

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Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
ERJ open research
volume
12
issue
4
pages
11 pages
publisher
European Respiratory Society
external identifiers
  • pmid:42639002
ISSN
2312-0541
DOI
10.1183/23120541.01453-2025
language
English
LU publication?
yes
additional info
Copyright ©The authors 2026.
id
1d229ec3-9e29-4c2b-a0df-11087491bf0d
date added to LUP
2026-09-02 14:47:53
date last changed
2026-09-02 17:29:07
@article{1d229ec3-9e29-4c2b-a0df-11087491bf0d,
  abstract     = {{<p>BACKGROUND AND OBJECTIVE: Chronic breathlessness is common and often leads to avoidance of symptom-provoking activities. Expectations of breathlessness influence behaviour and symptom perception, but the accuracy of these expectations remains unclear. The aim of this study was to examine the relationship between expected and experienced breathlessness, the moderating role of mental states, determinants of expectation accuracy and the influence of recent symptoms on future expectations.</p><p>METHODS: In this longitudinal study, 83 participants with chronic breathlessness rated expected and experienced breathlessness (on 0-10 numerical rating scales (NRS)) using a mobile ecological momentary assessment app over 7 days. Associations were analysed using linear and mixed regression models.</p><p>RESULTS: Expected breathlessness was significantly associated with subsequently experienced breathlessness (β=0.51, 95% CI 0.35-0.68) but was systematically overestimated (mean±sd expected 4.7±1.9<br>
 versus experienced 2.9±1.7; mean absolute difference 2.0±1.5). Depressive symptoms attenuated the association (β=0.40, 95% CI 0.23-0.58), whereas anxiety, wellbeing and self-efficacy were not associated with either the strength or the accuracy of expectations. Expected breathlessness for the upcoming week was strongly related to the experience during the study week (β=0.85, 95% CI 0.61-1.08, R<br>
 2=0.48), suggesting recent experience shapes expectations more than expectations predict future breathlessness.<br>
 </p><p>CONCLUSION: Individuals with chronic breathlessness overestimated future breathlessness by a mean of 2 NRS points. Indication of depressive symptoms influenced the strength of the association, but accuracy appears unaffected by mental state indicators. These findings highlight the need to address and recalibrate symptom expectations in clinical care.</p>}},
  author       = {{Sandberg, Jacob and Sundh, Josefin and Anderberg, Peter and Currow, David C and Ekström, Magnus}},
  issn         = {{2312-0541}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{European Respiratory Society}},
  series       = {{ERJ open research}},
  title        = {{Expected breathlessness is overestimated compared to experienced : a mobile ecological momentary assessment study}},
  url          = {{http://dx.doi.org/10.1183/23120541.01453-2025}},
  doi          = {{10.1183/23120541.01453-2025}},
  volume       = {{12}},
  year         = {{2026}},
}