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In response to the COVID-19 pandemic, study abroad (SA) programs have undergone an urgent transfer to the online format. Although SA online has many merits toward sustainable international education in the post-COVID era, assuring the quality of these programs and sustaining students’ learning motivation have been key issues of concern. Moreover, there is still a lack of evidence derived from in-depth qualitative inquiries. To address these gaps, this study takes a close look at an individual’s story using a narrative approach to data analysis and employs an ecological perspective focusing on intentionality as the theoretical framework for exploring how the participant conquered the challenges when they transitioned to SA online. Successful plots identified include setting up the online learning environment, optimising the benefits of online learning, and sustaining students’ motivation to study. Several obstacles remained unsolved, such as the loss of interpersonal connection and empathy in online communication. This study concludes that the participant’s successful and unsuccessful encounters in enacting the affordances of online education were manifested by developed or undeveloped intentional actions as a result of individual-environment mutuality. Some implications are offered for constructing sustainable online SA environments that can diversify and innovate future international education experiences.

Background and objectiveDiagnosis of asthma and COPD in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (‘asthma+COPD’) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both.MethodWe used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics, and lung function were compared between groups.ResultsOf the study sample (n=3522), 336 reported asthma-only, 172 reported COPD-only, 77 reported asthma+COPD, and 2937 reported neither. Fewer than half of participants with COPD diagnosis (with/without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (mMRC ≥2) than asthma-only (adjusted odds ratio [aOR]=3.44, 95%CI 1.86–6.33) or COPD-only (aOR=3.28, 1.69–6.39). Airflow limitation (GOLD 2 or higher, using post-bronchodilator FEV1/FVC <0.7) was similar between asthma-only and COPD-only, but twice as prevalent in asthma+COPD (aOR=2.18 and 2.58, respectively).ConclusionsAdults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma-only or COPD-only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.