title: Living with chronic obstructive pulmonary disease: insiders' perspectives.
abstract: OBJECTIVE
  This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives.
  
  
  BACKGROUND
  Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives. Previous qualitative studies on chronic obstructive pulmonary disease have tended to focus on specific problems associated with the disease, such as fatigue and social isolation.
  
  
  METHODS
  A hermeneutic phenomenological study was carried out with 10 older adults who participated in a local hospital's case management or pulmonary rehabilitation programme. Data were collected by interviews in 2003.
  
  
  RESULTS
  Three major themes were identified: Knowing What Works, Hanging On...Barely, and Losing Control-Gaining Control. The changes associated with chronic obstructive pulmonary disease were described as increasingly challenging and even threatening to participants' current lifestyles. The impact of dyspnoea was great and invaded almost every aspect of their lives. Participants identified the most effective methods to resolve shortness of breath.
  
  
  CONCLUSIONS
  People with severe chronic obstructive pulmonary disease have had extensive experience of managing their disease and are familiar with techniques that have helped them integrate the illness and symptoms into their lives. Nurses can synthesize patient knowledge with nursing knowledge to assist patients with severe chronic obstructive pulmonary disease to achieve their maximum quality of life.
authors.affiliation: Critical Care Clinical Nurse Specialist, WellStar Health System, Marietta, Georgia 30060, USA. danielle.fraser@wellstar.org
authors.forename: Danielle D
authors.initials: DD
authors.lastname: Fraser
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Kee
authors.forename: Ptlene
authors.initials: P
authors.lastname: Minick
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease; D004417:Dyspnea / Q000209:etiology / Q000523:psychology; D036262:Empirical Research; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology*; D011788:Quality of Life; D014481:United States