title: Living with chronic obstructive pulmonary disease: developing conscious body management in a shrinking life-world.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Concord Repatriation General Hospital, University of Sydney, Australia. janice.gullick@email.cs.nsw.gov.au
authors.forename: Janice
authors.initials: J
authors.lastname: Gullick
authors.forename: M Colleen
authors.initials: MC
authors.lastname: Stainton
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002908:Chronic Disease; D004417:Dyspnea / Q000209:etiology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011656:Pulmonary Emphysema / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012648:Self Care; D018434:Sickness Impact Profile; D055815:Young Adult