COPD is a chronic, complex, and incurable condition. It may result in declining pulmonary function, decreasing physical ability and loss of health related quality of life accompanied by symptoms such as anxiety, depression, fear, and fatigue. It is a major cause of morbidity and mortality and is currently ranked as the fourth leading cause of death in the world (Pauwels et al 2000; Downs and Appel 2007). Prevalence rates are estimated to be 24 million people in America, 2.7 million people in Germany,
300,000 people in Australian, 200,000 people in New Zealand, three million people in the United Kingdom, 1.5 million people in Spain and 2.6 million people each in Italy and France (Stang et al 2000, http://www.goldcopd.org/ Guidelineitem.asp?l1=2andl2=1andintId=989). These prevalence rates are thought to underestimate the true prevalence of COPD as many people are not diagnosed with the condition until they become symptomatic (Cross 2005; GOLD 2006).