Smoking in Chronic Obstructive Pulmonary Disease: A Need of the Taken-for-Granted Body

Abstract

Smoking is the major predisposing factor for chronic obstructive pulmonary disease (COPD), yet there has been little understanding of the embodied experience of smoking addiction for the person with chronic breathlessness and their close family members. This interpretive study applies Merleau-Ponty's existential philosophy of the body as a philosophical framework. Heideggerian hermeneutic phenomenology was the mode of inquiry used to gain understanding by engaging 15 people who were admitted to hospital for palliative surgery for emphysema, and 14 close family members in a total of 58 in-depth interviews. People with severe emphysema experienced smoking as a need of their taken-for-granted body. This need was experienced as an intense enjoyment, and as a response to triggers for smoking that were still perceived by the automatic body long after smoking cessation. People with COPD and their families described a link between heavy smoking and exacerbations of breathlessness that created a tension between continued smoking behaviour and awareness of smoking-related illness. Failure to overcome the body's addiction to smoking could lead to the person's denial of the relationship between their need to smoke and their worsening breathlessness. The need to smoke can lead to family anger that is mediated by each family member's personal experience of addiction. Even after cessation, the issue of smoking as part of the situation of COPD was in the foreground for family carers, as it was for the breathless people themselves. This discussion highlights the importance of ‘the right words at the right time’ in assisting a multifaceted approach to smoking cessation.