COPD stories of complex causal 'truths''Sure I've smoked all my life/but I also put in 37 years at the mine'

Secondary analysis was conducted to interpret the causes of illness stories told by patients living with chronic obstructive pulmonary disease. Despite the abundance of quantitative evidence regarding the causal relationship between smoking and chronic obstructive pulmonary disease, there is limited research that provides a contextual emic understanding of chronic obstructive pulmonary disease aetiology. Interview data from two earlier focused ethnography studies were examined by retrospective interpretation, a type of secondary qualitative research. Chronic obstructive pulmonary disease causation stories were identified in both primary study data bases, but were not previously systematically examined. The analysis was completed using an eclectic, explicit narrative approach that involved the examination of causation story elements. Participants told 104 causal stories about the development of their lung disease. They situated the aetiology of their chronic illness within a psychosocial reality. The causal stories told by participants demonstrate that those living with chronic obstructive pulmonary disease present a broader causal explanation for their illness, an orientation not commonly presented in the literature. They demonstrate the need for further examination of the important lay accounts of causes of illness in relation to chronic obstructive pulmonary disease. Clinicians' ability to hear an alternative understanding may be impeded when they only listen for what they already know, 'facts' concerning the relationship between smoking and chronic obstructive pulmonary disease. Addressing vulnerable persons in such a manner may impede patients' efforts to be responsible for the development of their chronic illness and individualised care.