Ensuring and improving assistance is important to prevent additional suffering and reduce exacerbations requiring hospitalization, a particularly important aim given the high and rising incidence of advanced COPD. A number of other insightful findings reveal the significance of learning directly from the persons who live with chronic illnesses about their lives.

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Aim: To explore the impact of living with advanced chronic respiratory illness in a rural area Methods: Using an interpretive descriptive approach, semi-structured interviews were conducted with seven people living with advanced chronic respiratory illness in a rural area of Western Canada.Results: Themes that characterised the experience of living in a rural setting with a chronic obstructive respiratory illness included: a) distance as a barrier to accessing health care; b) relationships with family practice physicians; c) supportive local community; and d) lack of respiratory education and peer support.Conclusions: Whilst living with advanced respiratory illness in a rural area posed some significant challenges, experiences of "place", conceptualised as a web of relationships embedded within a local context, are an important factor in rural residents' decisions to remain in situations where distance may present significant challenges to accessing health care.

Among pulmonary rehabilitation attendees, we explored their tendency to downplay versus acknowledge physical and psychosocial health limitations, and the subsequent impact either strategy had on how they perceive their own aging process. Participants (N = 87) were 44 to 82 years of age, and diagnosed with chronic obstructive pulmonary disease (COPD). The St. George's Respiratory Questionnaire measured their health limitations. The Attitudes to Aging Questionnaire captured their perspectives of aging. Participants downplayed their symptoms and psychosocial impact, and remained most positive about psychosocial loss and carefully reserved about psychological growth. Acknowledged activity impairment had negative consequences, however, for their perspectives of physical change. These findings signify a balanced identity and perspective of aging that supports the Identity Process Theory. We encourage nurses and other practitioners, and researchers in pulmonary rehabilitation setting, to use this theory to better understand how people with COPD adapt to aging.

There was a wide variation amongst surgeons in the choice of therapy for routine prophylactic immunosuppression as well as for the treatment of established corneal allograft rejection.