Perception of chronic respiratory impairment in patients' drawings

To explore the perception of dyspnoea in patients with severe chronic obstructive pulmonary disease.

Cross-sectional study using mixed methods.

Thirty-two patients with severe chronic obstructive pulmonary disease were included. Data collected included 3 health-related quality of life questionnaires (SF-36, St George and Maugeri respiratory questionnaires) and the Hospital Anxiety and Depression scale (HADS) to assess the impact of chronic obstructive pulmonary disease on quality of life and psychological functioning. Patients were then asked to draw their body and represent difficulties related to breathing. Drawings were coded and categorized. Patients' comments were transcribed.

HADS showed scores of depression and anxiety as high as 12.3 ± 2.6 and 9.3 ± 2.2, respectively; SF-36 subscales were severely affected, and the St Georges and Maugeri questionnaires indicated a high impact of chronic obstructive pulmonary disease (79 ± 13 and 60 ± 18, respectively). Drawings illustrated the pervasiveness of dyspnoea; patients' comments stressed breathlessness. Obstruction and tightening were salient, with a prominent representation of the head and internal structures, e.g. the lungs and the airways.

Patients' drawings capture a global expression of illness experience. They provide insight into the heterogeneity of patients' perceptions, and allow acknowledgement of patients' representations and experiences. This may, in turn, help in gaining patients' participation in rehabilitation programmes or adherence to new medications.