Chronic Obstructive Pulmonary Disease Essay

Chronic Obstructive Pulmonary Disease Essay Chronic Obstructive Pulmonary Disease Essay 45-year-old woman presents with chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields.Chronic Obstructive Pulmonary Disease Essay Permalink: https://nursingpaperessays.com/ chronic-obstruct…ry-disease-essay / In your Case Study Analysis related to the scenario provided, explain the following · The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms. · Any racial/ethnic variables that may impact physiological functioning. · How these processes interact to affect the patient. Must have 3 or more scholarly reference APA People must breath in order to live. The process of breathing (“respiration”, in medical terminology) is critical because it is the sole mechanism through which vital gasses such as oxygen and carbon dioxide can move between the air and the blood. When someone breaths in, oxygen is removed from the air and dissolved into the blood where it is used as fuel by the body’s cells. When someone breaths out, cellular waste products like carbon dioxide are removed from the blood and exhaled back out into the air. This complex transfer of gasses takes place in the lungs and involves a number of structures associated with the lungs that help move gasses between the lungs and the air: the bronchi (airways or passages within the lungs), and the alveoli (tiny air sacs composed of special membranes found at the end of the bronchi at which point the transfer of gases between the blood and the air occurs). Chronic Obstructive Pulmonary Disease (COPD for short) occurs when permanent blockages form within the pulmonary system (the term “pulmonary” refers to the lungs and respiratory system) that interfere with the transfer of vital gasses. Chronic Obstructive Pulmonary Disease Essay To be diagnosed with COPD means that some portion of one’s bronchi or alveoli have become permanently obstructed, reducing the volume of air that can be handled by the lungs. As this process progresses, the overall efficiency of the gas exchange process is reduced. There are two underlying disorders that can cause COPD: Emphysema and chronic Bronchitis. Bronchitis is literally an inflammation of the bronchi. The walls of the bronchi inside the lungs become inflamed, and this inflammation decreases the bronchi’s diameter so that less air is able to flow through than normal. The inflammation process promotes excessive production of mucous. Bronchial mucous, which serves to keep the airways clean and free of bacteria, is produced under normal conditions. However, the excessive mucous produced in bronchitis is thicker and more difficult to cough up than normal, and acts to clog the airways and inhibit lung capacity.Chronic Obstructive Pulmonary Disease Essay Emphysema also reduces the efficiency of the gas exchange process, only in a different manner. Emphysema affects the alveoli, specifically their sensitive membranes through which the gas exchange process occurs. Emphysema causes alveolar membranes to lose elasticity, become brittle, and then actually rip and tear. Broken alveolar membranes cannot be regenerated by the body. Each time alveolar membranes burst, more surface area within the lung necessary for gas transfer is permanently lost. As this process progresses, it becomes very difficult for patients to exhale because their weakened airways threaten collapse the harder they try to breathe out. The heart tries to compensate for the loss of oxygen available in the bloodstream by pumping harder and faster; a process associated with other serious complications including heart failure. Asthma is another respiratory disease that may be associated with COPD but which is not itself classified as COPD. People who have asthma have highly sensitive bronchi that are more reactive to environmental irritants like smoke, dust and pollen than are the bronchi of people who do not have asthma. During an asthma attack, asthma patients’ bronchi swell and narrow in a manner similar to what occurs in bronchitis, restricting the volume of gasses that can be transferred between the blood and the air. At this time, the exact relationship between asthma and COPD is unclear. However, there is some evidence to support the “Dutch Hypothesis” that both asthma and COPD have common genetic origins and may represent different expressions of a similar disease process. The jury is still out on whether the Dutch Hypothesis is accurate or not, but numerous researchers believe that it is at least partially true that asthmatic people may have a heightened genetic vulnerability for COPD.Chronic Obstructive Pulmonary Disease Essay As the number of smokers are rapidly increasing recently, the number of patients with COPD (Chronic Obstructive Pulmonary Disease) is also gradually increasing. It is one of the most common chronic diseases and is considered to be one of the five leading diseases following heart disease, pneumonia, HIV and AIDS worldwide (GOLD, 2004). Smoking is the main cause of COPD. However, long term exposure to chemical fumes and air pollution could also cause COPD. This essay is all about how COPD affects individual, family and society as a whole across their lifespan. Also, it discusses the role of a nurse in caring patients with COPD. Chronic bronchitis, emphysema and chronic asthma are the main three conditions that make up COPD. Emphysema causes…show more content… Due to the deterioration of their economic status they could feel embarrassed to face the society and might also feel burdened towards the family members and friends and might not want to participate in the social events. COPD is most common on people over the age of 35 and the risk of getting COPD gradually increases along with the age and the drug therapy costs £718 per patient every year (NICE, 2011). There are no cure for this disease. However, there are different treatment to prevent further deterioration of the lungs function in order to improve the quality of life of the patient by increasing capacity of their physical activity. One of the main severe complication a patient with COPD can develop is exacerbation. Increased breathlessness, increased sputum volume and purulent sputum are the signs and symptoms of exacerbation. Early detection of the signs of exacerbation can help keep the condition of the patient from worsening. The treatments of COPD mainly aims at controlling the symptoms of exacerbation such as taking inhalers. Patients who are over the age of 35 and ex-smokers with chronic cough and bronchitis are recommended to have spirometer (NICE, 2004). This is because it is possible to delay or prevent patients from developing severe case of COPD is identified before they lose their lungs functions. Oxygen therapy is another treatment for COPD as the patients with this condition has high Chronic Obstructive Pulmonary Disease Essay There is a long tradition within the sociology of health and illness of research that seeks to increase sociological knowledge about the ‘meaning and experience of chronic illness from both sufferers’ and their families’ own perspectives’ (Williams 2000: 42). Included among these are studies of the varying ways that lay people account for the development of a chronic illness and how they ‘make sense’ of their illness within the broader context of their lives (Williams 1984, 1992). Similarly there are a number of studies that attempt to understand cigarette smoking from the point of view of the smoker (Lawler et al. 2003, Parry et al. 2001b). These studies highlight the ‘multiple and often contradictory agendas of everyday life, smoking and health’ (McKie et al. 2003: 83). Over the last 15 years a third body of writing has also emerged within the sociology of health and illness (Hansen and Easthope in press, Petersen and Lupton 1996, Bunton et al. 1995). This body of writing has focused on the increasing popularity of lifestyle?centred explanations for health and disease within a broader framework of neo?liberal ideologies and health?related discourses stressing the importance of self?responsibility for health. Two common themes in sociological writings about lifestyle are the potential for guilt, blame and discrimination inherent in explanations for disease that emphasise self?responsibility and behavioural (and thus ‘preventable’) risk factors and the disinclination of many lay people to accept explanations for disease that focus on lifestyle behaviours (Davison et al. 1992, Frankel et al. 1991, Lupton and Chapman 1995). While there are many studies exploring how lay people link lifestyle behaviours such as smoking, with the prevention of disease or the maintenance of health there have been fewer studies that investigate how people affected by a chronic disease that is widely viewed as resulting from a particular behaviour or practice account for their illness.Chronic Obstructive Pulmonary Disease Essay Chronic obstructive pulmonary disease (COPD) is unusual among the disabling chronic illnesses because it has a widely accepted causal link with cigarette smoking; approximately 90 per cent of patients with diagnosed COPD are smokers or ex?smokers (McKenzie et al. 2003). This makes COPD unlike many of the other chronic diseases that have been investigated sociologically, such as arthritis, inflammatory bowel disease or multiple sclerosis where there are no widely accepted causal factors. Thus an investigation of the explanations given by people with COPD provides an opportunity to explore how those personally affected by a ‘lifestyle chronic illness’ account for their illness and either apply or resist medical and popular wisdom asserting a strong relationship between behaviour and their illness. Our qualitative study investigated a group of middle aged and elderly Australians living with COPD. In this article we focus on how study participants explained why they developed COPD and the role of cigarette smoking in their explanatory accounts.Chronic Obstructive Pulmonary Disease Essay Background to chronic obstructive pulmonary disease COPD is characterised by airflow limitation that is progressive and not fully reversible. The disease is predominantly caused by smoking (NHS 2004: 5). COPD is one of the world’s most common chronic diseases, the overall prevalence in adults appears to lie between four per cent and 10 per cent, based on population surveys in a number of countries where it has been rigorously measured (Halbert et al. 2003). Rates of COPD are higher among people in lower socio?economic groups and among men, however the rates for women are rising as a reflection of increased smoking by women in the second half of the 20th century and over the next 20 years death rates from COPD in women are expected to overtake those in men (Bellamy and Booker 2003, McKenzie et al. 2003). As COPD tends to develop after accumulated exposure to cigarette smoke and the disease has few readily apparent symptoms in its early stages, the majority of people with a diagnosis of COPD are middle aged and elderly (McKenzie et al. 2003).Chronic Obstructive Pulmonary Disease Essay Severe COPD is life threatening, and prognosis after a severe exacerbation is poor (Elkington et al. 2001). Individuals with COPD commonly experience shortness of breath on exertion (dyspnoea), chronic cough and excess mucus production. In severe COPD, those affected may feel breathless after only very slight exertion such as dressing, drying their hair or walking on flat ground. They are also prone to exacerbations with an associated worsening of symptoms that require hospitalisation (McKenzie et al. 2003). Current medical treatment for COPD focuses on smoking cessation (which may slow the progression of symptoms and damage), managing acute exacerbations, the use of inhaler medication and pulmonary rehabilitation therapy. Individuals in the later stages of the disease may also require oxygen therapy at home. These treatments have only a limited capacity to control symptoms (Lacroix et al. 1991).Chronic Obstructive Pulmonary Disease Essay The experience of living with COPD has been described by a number of authors (Bailey 2004, Fagerhaugh 1993, Oliver 2001, Seamark et al. 2004, Williams, S. 1993). These studies show that people affected by COPD have much in common with people affected by other chronic illnesses such as arthritis, multiple sclerosis or colitis (Davison et al. 1992, Kelly 1992, Williams 1984). However, the symptomatology of COPD such as disabling breathlessness, and the intensification of breathing difficulties associated with an acute exacerbation, means that COPD is a particularly frightening and debilitating illness (Williams, S. 1993). People diagnosed with COPD are also likely to experience the stigma associated with smoking?related illnesses and this may contribute to their disease burden (Dowson et al. 2004, Earnest 2002). It is worth noting the pervasive nature of the stigma surrounding COPD. The disease is described as a ‘self inflicted illness’ even in medical texts such as journal articles and guidelines (NHS 2004). COPD is associated with significant anxiety and depression although it is unclear whether this is related to the stress of having COPD or whether anxiety and depression are part of the condition (Bailey 2004, Dowson et al. 2004).Chronic Obstructive Pulmonary Disease Essay Widespread use of the term chronic obstructive pulmonary disease is a relatively recent phenomenon. Before the 1990s, chronic obstructive pulmonary disease was the preferred American term while the term chronic obstructive airways disease was favoured in Australia and the United Kingdom. Referring to emphysema and chronic bronchitis is still common among older doctors and GPs, as is a tendency to conflate COPD with adult asthma at a clinical level. Increasing sophistication in lung function testing, allowing doctors more clearly to differentiate between various respiratory conditions, has lead to a clarification of diagnostic labels between asthma and COPD. The term COPD clearly differentiates smoking?related obstructive lung disease from other chronic respiratory disease. Adoption of the term is associated with increasing international awareness of the burden of smoking?related disease and the changing environment of respiratory medicine characterised by the rise of international and national airways groups such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and associated reports (NHLBI/WHO 2001), the release of new guidelines for the diagnosis of airways disease (NHS 2004) and increased use of the Cochrane Database.Chronic Obstructive Pulmonary Disease Essay Explaining chronic illness A number of sociological studies have shown that how a person understands the cause of their illness has implications for the meanings they assign to the illness and how they manage the condition (Sanders et al. 2002, Williams 1984). Despite the inherent variability of lay accounts, a number of over?arching features of lay explanations for chronic illnesses are apparent. It seems that chronic illness requires a different type of explanation from short?term acute illness. Relatively simple explanations will often suffice to account for acute illnesses and many acute illnesses do have such an explanation readily available, for example attributing the illness to ‘an accident’ or ‘an infection’. In contrast, the disabling and often degenerative character of chronic illnesses are much harder to view as minor ‘blips’ in an individual’s biography. Chronic illness may constitute a ‘biographical disruption’ requiring a fundamental rethinking of a person’s biography and self?concept (Bury 1982, Lawton 2003: 23).Chronic Obstructive Pulmonary Disease Essay Furthermore, explanations for chronic illness cannot be separated from a larger illness narrative ‘a story the patient tells and significant others retell, to give coherence to the distinctive events and long term course of suffering’ (Kleinman 1988: 49). As such, a number of writers argue that people affected by severe chronic illness are unlikely to provide explanations for the illness that do not in some way make reference to that person’s life and experiences and that relate to how a person views themselves (Bury 1991 and 2001). Related to this point, it is important to acknowledge that for some people (particularly elderly people) chronic illness may be viewed not as a disruption but as a normal or at least a not entirely unexpected event (Bury and Holme 1991, Pound et al. 1998).Chronic Obstructive Pulmonary Disease Essay Lay explanations for chronic illness are also characterised by their dynamic, variable and socially embedded nature. A person’s geographical location, their age, ethnicity and gender, their social and economic resources and wider social and demographic influences will impact on how they experience and interpret illness (Blaxter 1983, Lawton 2003, Pierret 2003). For example the availability of economic resources will influence the strategies available for people to cope with a disabling illness. Similarly, the extent to which an illness leads to a challenging of expectations related to gendered attributes or behaviours will impact on the meaning and experience of the illness (Charles and Walters 1998, Lonsdale 1990, Williams, G. 1993).Chronic Obstructive Pulmonary Disease Essay Explanations for chronic illness change over time in response to life events, alterations in the illness and access to new information (Frank 1995). Illness narratives also tend to include a range of possible reasons why a person became unwell (Cornwell 1984, Herzlich and Pierret 1987, Whittaker 1995). Individuals often emphasise the aetiological importance of different factors at different stages in their life or at different points in their illness biography. Gareth Williams describes this process as ‘narrative reconstruction’ (Williams 1984). He argues that when explaining the cause of their illness, people are not only trying to provide a rational explanation for disease, they are also trying to create a place within their life for the illness; to ‘reconstitute and repair ruptures between the body, self and the world by linking and interpreting different aspects of biography in order to realign present and past and self and society’ (Williams 1984: 197). Thus, when a researcher asks a person with a chronic illness to explain why the illness occurred, their questions may be ‘explicitly translated into more substantive biographical questions’ and include references to factors such as bad luck, stress, significant life events, political, moral and spiritual factors and issues such as workplace exploitation or being a parent (Williams 1984: 196). For this reason lay explanations for chronic illness are more than mere attempts to provide an explanation for disease (something akin to a medical explanation focused on the physical). They are part of ongoing processes of identity construction.Chronic Obstructive Pulmonary Disease Essay Explaining disease in terms of lifestyle behaviours Explanations for health or disease that focus on the role of lifestyle behaviours and practices are a noticeable feature in several contemporary discourses on health and disease such as the ‘new public health’ and complementary and alternative medicine (CAM) (Bunton et al. 1995, McClean 2005). Health education campaigns based on a lifestyle approach to disease are widely implemented by governments in countries such as Australia, Canada and the United Kingdom (Palmer and Short 1994). The increasing application of lifestyle?focused explanations for health and illness, which stress the importance of self?responsibility for health, both reflect and reproduce a range of social processes that characterise the advanced industrialised societies of the late 20th century and early 21st century such as rationality, ideologies of conservative individualism (neo?liberalism), the increasing commodification of health and healthcare and the ‘risk society’ (Featherstone 1991, Nettleton 1995).Chronic Obstructive Pulmonary Disease Essay The ways that lay people talk about the relationships between lifestyle, health and disease have been investigated sociologically, as have lay perceptions of lifestyle?related risk factors for disease (Davison et al. 1991, Whittaker 1995). In the main, these studies have focused on how people explain the prevention of disease or the maintenance of health rather than investigating how people already affected by a particular lifestyle?related illness make sense of and explain their condition (with the notable exceptions of HIV/AIDS and hepatitis C). Lay discussions about the reasons why people develop particular diseases tend to emphasise biological factors such as germs or genetic susceptibility rather than lifestyle factors (Blaxter 1983, Calnan 1987). Davison and colleagues (1991) suggest that one reason for lay peoples’ disinclination to accept the arguments about lifestyle and disease which they encounter in health promotion is the seemingly contradictory evidence they see for themselves: friends who have smoked and not developed lung cancer; people with lifestyles characterised by lack of exercise and diets high in cholesterol who do not develop heart disease. They argue that lay people use many different sources of information when constructing hypotheses about the causes and risks of illness.Chronic Obstructive Pulmonary Disease Essay These may include information from health professionals, health promotion material, magazines and television shows, and evidence acquired through their own observations. This process has been termed ‘lay epidemiology’ or ‘popular epidemiology’ (Davison et al. 1992 and 1991, Frankel et al. 1991). Nettleton (1995) suggests that there may also be a distinction in lay logic between health and disease. ‘Whilst people consider that diet, exercise, rest and relaxation might contribute to maintaining health, it does not follow that such activities will prevent the onset of illness or disease’ (1995: 45). Several recent studies where lay people were surveyed or interviewed show that lifestyle factors such as exercise and diet are becoming increasingly accepted as causes of disease (Blaxter 1990, French et al. 2001 and 2005). These studies have however rarely asked people questions about an illness known to be affecting them. Thus, less is known about the ways that lay people are using lifestyle models when they construct explanatory accounts for disease that already affects them (one close to them) or how this might impact on their illness experience or behaviours. Explaining why they have been personally affected by a particular illness is an issue of particular importance for those people affected by a chronic illness such as COPD where the development of that illness is closely linked by medical research and/or popular opinion with certain events or behaviours such as cigarette smoking. Chronic Obstructive Pulmonary Disease Essay Research into the experience of having cardiovascular disease or type two diabetes suggests that explaining one’s own illness in terms of behaviours and actions may be quite damaging in terms of self?blame and guilt (Broom and Whittaker 2004, Elofsson and Ohlen 2004, Richards et al. 2003). Broom and Whittaker (2004) describe how the lay epidemiology of people with diabetes (a condition also perceived by health professionals as a ‘lifestyle disease’) draws on a number of explanatory factors such as stress, bad luck and inheritance to propose ‘a wider causality which can normalise the condition and minimise the moral implications of the illness’ (2004: 2372). Perceiving one’s own illness as arising from a lack of self?control may also lead to delays in seeking medical attention because those affected see themselves as being somehow less deserving, or feel concerned about the possibility of medical censure (Richards et al. 2003).Chronic Obstructive Pulmonary Disease Essay Methods Our qualitative research study was part of a wider research project investigating the diagnosis and management of COPD in primary care (Hansen 2003, Walters et al. 2004, Walters et al. 2005). GPs in two large Australian general practices identified patients with COPD from a prescribing database by use of medication. Patients with cognitive impairment or another serious medical condition were excluded from the list of people invited to join the larger study. From among those who agreed to participate in the larger study we used purposive sampling to recruit participants for semi?structured interviews aiming to explore lay explanatory models of COPD and the impact of COPD on the participants’ everyday lives. Interviewees were selected with a balance of gender, age, marital status, geographical location of residence and varying degrees of COPD severity. Recruitment for interviews ceased when our analyses suggested a level of data saturation had been reached (Patton 1999). Our interview guide was based on Kleinman’s list of suggested questions for eliciting an explanatory model with the addition of reminder prompts for the interviewer to follow up the issue of cigarette smoking if it was not mentioned by the interviewee (Kleinman 1988). Our guides were reviewed before each interview and sometimes altered to reflect emerging areas of interest or insights gained in previous interviews (Seidman 1998, Hansen 2006). Additional topics or questions were often raised during the interview (see Appendix A Sample interview guide).Chronic Obstructive Pulmonary Disease Essay Six months after the initial interview a sub?group of interviewees participated in a follow?up interview. The follow?up interview allowed participants to comment on the initial analysis (member checking) and for the researchers to follow up themes emerging in the analysis. They also allowed the researchers to explore any changes in the participants’ explanatory accounts over the six months and to investigate the impact of participation in the larger study on the way that participants talked about their illness. All the interviews were conducted in participants’ homes. They were tape recorded and transcribed in full. The transcripts were analysed by one member of the research team within an iterative interpretive framework that drew on aspects of grounded theory and narrative analysis (Charmaz 2002, Frank 1995). Each transcript was read as soon as possible after the interview and given initial codes and memos. Particular attention was paid to repeated stories, claims and phrases, links made between events and illness and how the participants spoke about smoking.Chronic Obstructive Pulmonary Disease Essay This iterative process was repeated as more interviews were conducted and transcripts were then compared with each other. Codes were grouped into larger categories and, after ongoing iteration (compare and contrast) and dependability testing through member checks (follow up interviews), these categories were grouped into major themes. At this stage the analysis was presented to three other members of the research team who read through the transcripts and the analysis to ensure the thematic categories accurately reflected the interview data and to provide a degree of investigator triangulation (Grbich 1999). Among these major themes were different types of explanatory accounts given by the interviewees. These accounts were organised into groups according to the relative importance attributed by the interviewees to cigarettes as an explanatory factor for their illness. These findings are presented below. Findings Information on the study was sent to 91 people and 45 agreed to participate. All study participants completed a clinical assessment, including spirometry and questionnaires (anxiety and depression screening, St George’s Respiratory Quality of Life Questionnaire (SGRQ) and the European Community Respiratory Health Survey). Patient records were reviewed to extract data on diagnosis and management. Nineteen of the study participants were recruited for a semi?structured interview (see Table 1). Eleven of these participated in a second (follow?up) interview. The age of interviewees ranged from 49 to 80 years. Only six men were interviewed compared with 13 women. The interviewees lived in suburbs surrounding the two general practices. These suburbs are classified as disadvantaged socio?economic areas. Most of the interviewees owned their home or flat but all were living on a limited income such as retirement or disability pensions. None of them had an education level higher than 10th grade and prior to retirement they had worked in fields such as mechanics, bar tending, fishing, cleaning and nursing. Several of the women had been full?time homemakers.Chronic Obstructive Pulmonary Disease Essay Table 1. Interviewees’ age, sex, employment/work status (All names are pseudonyms) Name Age Sex Employment/Work Status Bessie 70 years F Retired Anne 69 years F Retired Sue 76 years F Retired Don 74 years M Retired Janine 64 years F Retired Dolly 74 years F Retired Katherine 57 years F Disability Pension Oscar 55 years M Retired Mark 69 years M Retired Paul 73 years M Retired Jamie 78 years M Retired Jocelyn 78 years F Retired Amelia 60 years F Retired Jessica 49 years F Retired Mandy 49 years F Disability Pension Jane 60 years F Retired Sarah 59 years F Retired Bronwyn 49 years F Disability Pension Billy 71 years M Retired In an effort not to impose a medical diagnosis on the participants (or to assume that interviewees would agree with the medical diagnoses recorded on their case notes) the interviewers began each interview by asking the interviewee to tell them about their breathing problem. Through this they were usually able to quickly identify the interviewees’ preferred name (or names) for their illness. None of the interviewees used the terms chronic obstructive pulmonary disease or COPD, preferring instead to describe their illness as emphysema, asthma or bronchitis (sometimes as a combination of these).Chronic Obstructive Pulmonary Disease Essay Their accounts were organised into four different explanatory categories. These categories are structured around the ways that participants described the role of cigarette smoking in their development of COPD. They are summarised in Table 2. Table 2. Categories of explanatory accounts for participants’ respiratory illness Name of category Key features ‘Smoking’ Participants giving these accounts explained their illness as resulting from cigarette smoking. They drew explicitly on ‘medical knowledge’ (usually their doctor) as a source of legitimation. Their accounts were characterised by expressions of concern such as ‘why did smoking do this to me and not to all other smokers?’ and expressions of confusion, guilt and self?blame. ‘Industrial exposure and smoking’ Participants giving these accounts attributed their illness to a combination of workplace exposure to respiratory irritants and cigarette smoking. They were able to explain why they had developed a respiratory illness when many other smokers were apparently unaffected. They did not express resentment about dangerous work places or working conditions.Chronic Obstructive Pulmonary Disease Essay ‘Inherited predisposition and smoking’ Participants giving these accounts explained their illness as resulting from an inherited predisposition for breathing difficulties that was exacerbated by cigarette smoking. They described themselves as part of a family chain of asthma and bronchitis sufferers. There was a sense of the inevitability of respiratory illness in their accounts. ‘Inherited predisposition alone’ Participants who gave these accounts described their illness as a family sickness and strongly resisted attempts by the interviewer to discuss the role of cigarette smoking. They were very sceptical about medical explanations for their illness that mentioned cigarette smoking. ‘Other/Unclear’ These participants did not give an explanatory account for their illness or did so briefly that their accounts could not be categorised.Chronic Obstructive Pulmonary Disease Essay Smoking The four participants whose explanatory accoun