This exploratory study describes how persons with pulmonary emphysema manage their condition in their natural environment. A sample of eleven persons was inter-viewed and observed in their homes. Data were collected on the person's awareness of the disease, how he managed symptoms and disability, how he felt the disease had changed his life, and how he had adjusted to the changes. The single most powerful force in the home discovered to support coping endeavors was the presence of a significant other person. Eight of the eleven persons interviewed were living with their spouses and were more or less dependent upon them. Those without significant other persons found it necessary to rely upon outside assistance. Stages through which patients with emphysema pass were identified as a submerged period (man-ifestations of the disease imperceptible), a period of emerging awareness (symptoms perceived), a deceleration-into-retirement period (symptoms became limiting), and a period of slow motion (perpetual slowdown in activities). The two main concepts to emerge from the data were "simplification of activities" and "pacing," which could be subsumed under "planning ahead to maximize economy of effort." Techniques for accomplishment of these goals and adjustments to sociological and physiological changes included organization of personal effects and the home environment to make use simpler, use of medicines and breathing techniques to prevent attacks during increased exertion, resting between activities, and increased use of mechanical de-vices to save personal energy.
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