Chronic Obstructive Pulmonary Disease (COPD; including chronic bronchitis and emphysema) is a long-term  disease characterised by progressive and irreversible air flow reduction¹. Chronic lung disease has a major impact on the health and disability of all Australians. It is the fifth biggest killer and the third leading cause of disease burden after heart disease and stroke². It is the third greatest contributor to disability and premature mortality in Aboriginal and Torres Strait Islander Peoples³ and accounts for 5% of lost years of life⁴.

Unfortunately COPD is often under diagnosed and undertreated¹. Symptoms of chronic lung disease can creep up slowly on an individual. Breathlessness and decreased physical activity lead sufferers to reduce their daily activities until symptoms are so severe that they are increasingly unable to participate in basic activities of daily life such as showering or dressing.

Although there is no cure for COPD early detection is important for effective disease management. The key aims of treatment are; improve quality of life, increase exercise tolerance and ability to participate in activities of daily life, and keep out of hospital.

Pulmonary rehabilitation is a proven self management program that is effective in improving quality of life for people with COPD, increasing exercise tolerance and more importantly reducing hospital admissions¹. Guidelines for the management of COPD in Australia and New Zealand (COPD-X), were developed and access to PR is strongly recommended for patients with moderate to severe disease⁵. Data collected by The Australian Lung Foundation before 2000 reveals that fewer than 1% of patients with COPD have access to Pulmonary Rehabilitation⁶.

In 2005 The Australian Lung Foundation presented a funding submission to the Federal Government to advocate for a national approach to the diagnosis and treatment of COPD¹. This submission outlined 6 key recommendations that can significantly relieve the burden of COPD in Australia. Its first recommendation was "Increase access to pulmonary rehabilitation".

In 2007 The Australian Lung Foundation's pilot project Breathe Easy, Walk easy, Better lung health in rural and remote Australia train the trainer package began a series of pilot workshops to test the package content in meeting local needs. The priority areas of this project were building links and collaborative partnerships across the disciplines and health care sectors to enable a more comprehensive approach to meet lung health needs of rural and remote communities in the Kimberley region of WA and the Top end of the Northern territory.

In response to community health provider's request for training to deliver pulmonary rehabilitation to their patients the Breathe Easy, Walk Easy project team successfully obtained a short term grant from The Rural Primary Health Section, Rural Health Services and Policy Branch, Office of Rural Health, Department of Health & Ageing (February 2009-June2009).

This grant enabled us to test the training packages' strength in increasing the capacity of rural and remote health care providers to deliver a pulmonary rehabilitation program in their area. The first training was held in May 2009 at an Aboriginal Medical centre in rural NSW. Initial and three month post training evaluation showed a significant increase in:

• Participants' confidence in areas relating to the care of patients with chronic respiratory disease – particularly relating to exercise testing, prescription and training.
• Participants' knowledge in assessing and managing patients with chronic respiratory disease particularly relating to Pulmonary Rehabilitation.
• Participants' skills in assessing and managing patients with chronic respiratory disease particularly relating to Pulmonary Rehabilitation.

In July 2009 the project received further funding from the Department of Health and Ageing Chronic Disease Self-management and Risk modification Grants (CDSM) as part of our ongoing community evaluation process. We have recently held training in Griffith NSW and are currently in the process of evaluating the immediate impact on training participants. We anticipate further evaluation at three months and six months post training.

We are presently in the process of organising training in Alice Springs for February 2010 with a subsequent three month post training evaluation. On completion of these two community based evaluations the Australian Lung Foundation will look to roll out its program on a national basis.

• Staying Healthy with Lung Disease ( pdf - 362 KB) - Community health brochure about exercise and lung disease.
• Australian Lung Foundation website

1. The Australian Lung Foundation, Chronic Obstructive Pulmonary Disease Knocking the wind out of over one million Australians, A National Approach to COPD – Funding Submission 2006
2. Australian Institute of Health and Welfare 2000. Australian Health 2000: the seventh biennial health report of the Australian Institute of Health and Welfare. Canberra: AIHW
3. Vos T, Baker B, Begg S, Stanley L &Lopez A 2009. Burden of Disease and injury in Aboriginal and Torres Strait Islanders peoples: the Indigenous health gap. International Journal of Epidemiology 38:470-7
4. Australian Bureau of Statistics 2008;4704.0
5. McKenzie DK, Abramson M, Crockett AJ, et al. The COPDX Plan: Australian and New Zealand Guidelines for the Management of COPD 2007.
6. The Australian Lung Foundation. Case statement: chronic obstructive pulmonary disease--Australia and New Zealand. ALF, 2001.

If you would like more information about this project please do not hesitate to contact

Manager Rural and Remote Lung Health, The Australian Lung Foundation
Phone: 08 9192 6436
Mobile: 0448 176 093