**7. Losing independence with body care**

Severe COPD sees people coming to terms with their diminishing ability to care for themselves. Early losses in independence may include difficulty with shopping or driving. As the disease progresses, people find that basic tasks such as showering and dressing may become insurmountable, making them feel almost child-like in their dependence on others (Gullick, 2008, Oliver, 2001, Barnett, 2004). Chris was sensitive to his wife's workload around body care*. "I'm nearly an invalid, aren't I? She has to help me up the stairs… shower me… help me get dressed. Basically the stupid things I should be able to do myself"* (Gullick, 2008).

This loss of independence with self care is an enormous threat to people's sense of hope (Milne et al., 2009). Showering causes particular problems because of the effect of steam on breathlessness. Pete explained, *"I panic a little bit when I get in the bath or shower, and then I've got to get out and get dried up. I'm pushing for my breath, … and I dry one leg down to my ankle and …stand there and hang on to something until I get my breath and then I put the other leg up".*  Lifting arms to wash the hair, or bending to dry the feet are movements that cause considerable restriction to breathing, and so may be avoided. For people who live alone, this loss of self care may herald their movement into residential care. For people with family carers, it may alter the existing family relationship dynamics (Barnett, 2004, Gullick, 2008).
