Table 3– Examples of quotes to support the themes and subthemes of the conceptual framework.

Quotes	Themes
“But, you know, I take things easy, right. If I have to climb stairs I have more difficulty than I have here (i.e. in the hospital), you see. Today I can take the sun pretty well, I mean, I can walk, but once it goes uphill I’m in trouble. When I get home I have to climb a hill, 5 metres up. First it goes slightly up and then I have to climb stairs but then I have to go and sit down for a bit. I do feel it then. I mean, that I'm out of breath. It only takes 5 minutes, but then I have to lie down again – that’s at 7 o’clock in the morning – and then I recover.” (Belgium, interview 3: male, age 65 years, GOLD stage II)	Doing things slower Difficulty climbing stairs Difficulty going uphill Taking breaks/time needed to recover
“To make myself clear, because we shouldn't lie now, I'm not at the level I want to be. To make it… you therefore divide it into breaks, you stop at the stairs with the bags and you begin again… At the stairs or, I don’t know, let’s say, in the street where I carry the trolley from the farmers’ market, let’s say, it's a distance of 200 to 300 meters, 400 to 500. Because even at the farmer’ market you come and go, you come and go. You don’t stay in one place, because in that case there’s no point going to the farmers’ market… And when I get tired, I look for a crate, let’s say, at the farmers’ market. If I’m tired, I take a break. I sit on the crate… oof… I say something silly to an Olympiakos fan, to a Panathinaikos fan and I start again and make it to the house. That is, I try to gain, let’s say, metres, to give myself some time and to catch my breath and to raise my morale.” (Greece, focus group 1: male, aged 57 years, GOLD stage II)	Taking breaks Problems with walking Difficulty climbing stairs Tiredness Time needed to recover Breathlessness
“I live on my own, so my housekeeping must also be done. For example, when I have to mow the lawn, I just have a small garden and I have to mow that, and the neighbours have to too. Otherwise I get discredited so that does have to happen. And then I do that in three goes. So do a bit, and then I go back inside, lie on the bench and then, eh, then I think, yes I am back, and then I go back. Then I do it… What used to take a quarter of an hour, that garden, I now do in more than an hour and a half. I pant, then I pant, so I then quit. Now I almost never want to walk. And cycling, that goes very well, but that is with a cycle with support. That is, that is the invention of the century.” (Netherlands, focus group 2: male, aged 71 years, GOLD stage I)	Problems with tasks outside and walking Taking breaks/interrupting activities Time needed to recover Breathlessness Using aids (e.g. electric bike)
“Getting dressed and undressed when I’m so short of breath, I need my wife for that as well, you know. Also when you go for a bath and you’re sitting there in a small room with all the steam and less oxygen… that is actually the thing I'm most sensitive to…getting my breath. So that’s not something that I go and do every day, you see! I look at that as split tasks, you know. Having a bath, drying yourself and whatever, you have to divide that up as well, right. And that’s bending and straightening up, isn’t it. Because how else are you going to get your feet dry? And the days that I do those things I know that I mustn’t plan too many other things.” (Belgium, interview 5: male, aged 64 years, GOLD stage IV)	Spreading and planning activities Difficulties bathing and getting dressed Breathlessness Difficulties bending over Needing help from others
[About social activities] “I had to give them all up. I’ve done a lot of work outside and that. I had the pigeons but had to gee [give] them up right away. There are a lot of things I’ve had to give up, you know. Well playing football, like football and that. Can’t walk along the corridor, never mind run. And as I said, when you go out with your wife and she’s carrying two big bags and your walking along there with nothing, people must say to themselves “oh look at that man his wife carrying the bags and he’s got nothing”, but at the end of the day they dinnae ken [don’t know] what’s happening inside you!” (UK, focus group 2: male, aged 65 years, GOLD stage II)	Giving up the things you like Problems with walking Needing help from others
“There a great deal of things that are the same. I do things and of course I am not 20 any longer, but I do things. It’s normally more slowly and indeed, and then I do take a puff, but it sometimes it does take you by surprise. Er, it’s happened to me a few times as if everything pinches tightly. It has happened a few times now, so I normally try to make sure that it doesn’t happen again. But with extra efforts, walking on the stairs and like that, it does happen to me. Really serious things, then I think, “rest for a bit” because otherwise it won't be good. And one time it goes fine and the other time, then is [pretends to be out of breath]. That is mad, it is never actually the same.” (Netherlands, focus group 2: male, aged 63 years, GOLD stage II)	Doing things slower Taking medication Breathlessness Difficulty climbing stairs
“I couldn't walk. That means that I’ve got a fold up wheelchair, ehm which I use quite a lot. I’ve now bought myself a scooter, like yours P5, which I find I am more independent on a scooter than in a wheelchair, you know, I can stop at a shop and say I’m here [laughs] and I don’t have to shout “stop”. So, that’s the only way I can go shopping now, I can’t I can’t walk through a shopping centre without… the breathing is bad but it it’s also it’s is agony for me because your … your struggling to breathe, you have to keep stopping and people stop and look at you and you feel like dirt on the floor [laughs]. It is bad, very very bad when you can’t breathe.” (UK focus group 2: female, aged 70 years, GOLD stage III)	Difficulties walking Using aids Breathlessness Taking breaks/interrupting activities
“So, you are breathing with difficulty and you are fighting to recover from your legs and from your breathing so that you can walk another ten metres. And the same again at the next ten metres. A stop. You can’t go any longer. Concerning stairs… um… um… in the morning I think and say, “I will go, let’s say, two to ten steps to go there, but how will I go?” Because I must also make such stops, and I must know where to sit.” (Greece, focus group 1: male, aged 72 years, GOLD stage II)	Leg problems Breathlessness Problems with walking Taking breaks and planning activities Time needed to recover

GOLD: Global Initiative for Chronic Obstructive Lung Disease.