Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life-world.

Aim: This paper is a report of a study to explore the changes experienced by the person living in a body with chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease is the world's fourth leading cause of death, and the World Health Organisation predicts further increases in prevalence and mortality. Despite a growing body of associated knowledge, there remains much to learn about patient and family-driven goals for medical and surgical treatment to guide nursing practice, to support self-management strategies, and to provide a context for therapeutic outcomes.

Methods: Merleau-Ponty's philosophy of the body provided a framework for this Heideggerian phenomenological inquiry with 15 people with emphysema and 14 of their family members. The participants were drawn from three Australian teaching hospitals. Hermeneutic analysis was used to interpret 58 in-depth interviews conducted between 2003 and 2005.

Findings: People with severe emphysema experience a shrinking life-world shaped by breathlessness. This diminishes the predictability and automatic nature of their bodies and their perceived effectiveness as a person. They develop a number of strategies of conscious body management to facilitate breathing, mobility and task completion.

Conclusion: Understanding of the person's changed body and the resulting expertise that those living with chronic illness bring into care and assessing and facilitating this expertise are central to planning sensitive and appropriate care and evaluating outcomes for medical or surgical therapies that are perceived as meaningful to the person.