Table 4.

Symptom and Interventions.

Symptom	Example interventions considered:
Chest and pleuritic pain	• Education of self-management strategies (avoiding over exertion)
	• Medical management occasionally required such as electrocardiogram (ECG) screening to rule out potentially life threatening diagnoses
Repeated chest infections	• Secretion clearance strategies
	• Swallowing screen for aspiration then medical management if required
	• Medical management to optimize underlying respiratory conditions may be required
Muscular and joint pain	• Hot/cold therapy
	• Exercise prescription for pain related deconditioning
	• Multi-disciplinary team discussion if potentially neuropathic pain
Shortness of breath at rest	• Assessment of breathing pattern to rule out Breathing Pattern Disorder
	• Use of Borg Rating of Perceived Exertion Scale (RPE) and oximetry
	• Breathing retraining (Diaphragmatic and nasal)
	• Assessment of N-terminal pro-brain natriuretic peptide (NT-proBNP) if indicated
	• Diffusing capacity for carbon monoxide (DCLO) and overnight pulse oximetry warranted in a minority of complicated cases
Shortness of breath on exertion	• Breathing techniques whilst moving
	• Purse lip breathing strategies if nasal breathing effortful
	• Positioning
	• Use of fan
	• Using Borg-RPE scale and oximetry with activity to guide and educate patient to safe level exercise
	• Assessment of NT-proBNP if indicated
Desaturation on exertion	• Use of pulse oximetry to relate to breathlessness score on Borg-RPE scale, and recovery time
	• Review how patient manages desaturation
	• Grade up activity gradually starting with non-de-saturation tasks
	• Education of self-management and breathing control for recovery/managing desaturation
	• Positioning
	• Assessment of NT-proBNP if indicated
	• Assessment of need for further respiratory investigation
Palpitations and tachycardia	• Medical assessments such as ECG, ambulatory ECG, and thyroid function, biomarkers and exercise testing
	• Advice around exercise
	• Medical management including salt loading and hydration volume, medications
Dizziness	• Vestibular retraining if indicated
	• Investigate whether related to postural drop or Postural Tachycardia Syndrome (PoTS)
	• Education/advice around postural drop and positional changes
	• Medication review
Post viral fatigue or post-exertional malaise	• Diaries (fatigue/sleep/thinking)
	• Education around pacing and prioritization
	• Identification of own unique occupational balance
	• Education on relaxation strategies and “quality” rest
	• Lifestyle management (diet, sleep and stress management)
	• Enrolment onto virtual fatigue course
	• Vocational support
Anxiety and depression	• Enrolment onto virtual fatigue course
	• Education on relaxation and mindfulness
	• Use of restorative activity
	• Referral to psychological services/Leeds Wellbeing service
Poor memory and concentration	• Cognitive assessment if indicated
	• Education around cognitive processes and post viral syndrome
	• Brain Training exercises (eg, Luminosity)
	• Diaries- fatigue/sleep/thinking
	• Vocational support
	• Memory aids
	• Education on relaxation and mindfulness
	• Use of restorative activity
Voice Disorders Upper airways Disorders Reflux related laryngeal symptoms	• Voice care advice and therapy
	• Inducible laryngeal obstruction (ILO) management
	• Cough suppression techniques
	• Education and support of post viral laryngeal recovery
	• Specific relaxation techniquesand CBT strategies
Word finding difficulties (anomia)	• Linguistic approach to improve semantics
	• Cognitive approach to improve verbal short-term memory and speed of naming
	• Compensatory approach, for example, circumlocution
	• Interventions may be provided in person and/or via computer therapy to support dosage/independent practice