Table 2.

Complex physical and mental health illnesses.

Subtheme	Quotes
Mental health issues are prevalent and linked to COPD severity	“In chronic disease, they [mental health illnesses] are relatively common and in COPD probably particularly common. Especially as you get to severe COPD, extremely common.” (HP5, Respiratory physician, male)
Mental health issues are part of multi-morbidity	“They often have multiple, multisystem diseases and a lot of things that interact. So I think it’s just the selected population that I would see will often have a lot of medical problems, and with that a lot of psychiatric issues.” (HP7, Respiratory physician, male)
Differentiating mental health issues from physical symptoms	“Sometimes it can be difficult to disentangle their somatic symptoms of their breathlessness on exertion, and anxiety. But the two interplay.” (HP3, Respiratory physician, male)
Complex, chronic mental health issues	“Some of them [COPD patients] might be schizophrenic, some of them might have PTSD, some of them might have childhood abuse, so there’s other groups of people that we find really hard to help because their problems have been very long-standing and whatever’s been offered has probably already been offered to them before in the past.” (HP2, Community centre nurse, female)