CIRCLES: Clinicians Improving the Rural COPD Landscape through Education in Self-care Goals


More than 16 million Americans, including more than two million people who reside in rural and remote areas of the United States, live with chronic obstructive pulmonary disease (COPD). Millions more may be living with the disease but not yet diagnosed.

Recent studies indicate that people living in rural and remote areas have higher rates of COPD than people residing in metropolitan areas and account for a disproportionate amount of all COPD-related hospitalizations, emergency department visits, and deaths. Additionally, people in rural communities often have completed less schooling and live with greater financial stress, which can lead to limited access to health care and COPD-related resources such as specialty care and pulmonary rehabilitation.

The United States Census reports that approximately 60 million Americans live in areas defined as rural. Studies show that rates of COPD are significantly higher in these parts of the country (8.2%) compared to metropolitan areas (4.7%). Many factors contribute to this higher prevalence, including higher smoking rates and increased occupational exposures. In the U.S., 80% of people with COPD receive at least some of their care from primary care clinicians, with higher rates in rural and remote areas. Often that care is not optimal and rarely involves enhanced patient education or support, such as tools for self-management.

The Project

In 2020, the COPD Foundation was awarded a contract from the National Heart, Lung, and Blood Institute (NHLBI) as part of their Learn More Breathe Better campaign. Termed the CIRCLES project, this initiative aims to improve communication between rural patients and health care providers (HCPs) and help them engage in effective self-management of their COPD using the free COPD Pocket Consultant Guide (PCG) app (free via the Apple AppStore or Google Play), My COPD Action Plan, and educational videos. The Foundation partnered with Rural Medical Education Collaborative, experts in rural clinician education and engagement, on the first phase of this project, piloting the materials in two rural primary care clinics.


When the CIRCLES I project was completed, the COPD Foundation hosted two webinars informing the community about the initiative, our approach, results, and lessons learned. These findings from individual interiews showed:

  • Participants found the toolkits helpful but some had difficulties navigating the PCG app and/or had limited access to smartphone technology.
  • The game board and My COPD Action Plan were seen as helpful self-management tools.
  • Patient education videos provided useful information to emphasize important points.
  • Activity and symptom tracking tools in the PCG app were found to be the most helpful to participants.
Patient-Focused CIRCLES Webinar

CIRCLES update for those living with COPD

Effective COPD self-management and better communication with your health care team is essential. Learn more about our CIRCLES initiative and what we learned about improving care in rural communities

HCP-Focused CIRCLES Webinar

CIRCLES update for health care professionals

How can you work with patients to encourage them to engage in better self-care and also improve communication? Learn more about our CIRCLIS initiative and how we are working to address the challenges facing patients and HCPs in rural America.


In 2021, the COPD Foundation embarked on a new phase of CIRCLES, based on feedback gathered in the project's first phase. The CIRCLES II initiative, supported by AstraZeneca, focuses on a low-tech approach to education to reach patients living in rural areas who may not have access to smartphone technology or Wi-Fi. The program toolkit from the CIRCLES I phase was redesigned to include self-management support tools, including a CIRCLES Fit Kit. These kits include:

  • A tote bag to hold all project essentials.
  • An interactive workbook* that discusses important COPD-related topics such as exercise, nutrition, medications, mental health, and more.
  • A copy of the My COPD Action Plan for monitoring symptoms and identifying exacerbations.
  • A copy of the Tips for Living Well with COPD flyer that offers helpful information on staying healthy and managing COPD symptoms.
  • An updated game board* to help participants navigate the PCG app.
  • A pedometer to track participants' activity.
  • Health and wellness items.
  • Six videos* that introduce the participants to the CIRCLES II program and toolkit components

*CIRCLES II videos and materials for download are available below.

The Foundation recruited U.S. pulmonary rehabilitation centers and health clinics to participate in this initiative, agreeing to incorporate the resources into their patient education curriculum and distribute kits to patients with COPD. The CIRCLES II program included locations in 13 U.S. states. The Foundation gauged program satisfaction in 2022 through post-project satisfaction card responses; this information will help the COPD Foundation team continue to improve the program for future participants. Learn more about the program's findings in the CIRCLES II program flyer.


The CIRCLES Project: Introduction

The CIRCLES Project: Introduction

The COPD Foundation's CIRCLES Project is designed to help individuals in rural areas better manage their COPD. Learn more about the CIRCLES project and get an inside look at the program's toolkit in this video.

The CIRCLES Project: Goal Setting

The CIRCLES Project: Goal Setting

Goal setting is an important part of the COPD Foundation's CIRCLES Project. Find out why goal setting is important for COPD self-management and join us in setting new health goals today.

The CIRCLES Project: The Workbook and the Game Board

The CIRCLES Project: The Workbook and the Game Board

The COPD Foundation's CIRCLES Project features an interactive workbook and game board that is based on the COPD Pocket Consultant Guide app. Explore the pages of the workbook and learn how to navigate the COPD Pocket Consultant Guide app by using the game board.

The CIRCLES Project: My COPD Action Plan and Tips for Living Well with COPD

The CIRCLES Project: My COPD Action Plan and Tips for Living Well with COPD

The COPD Foundation's My COPD Acton Plan and Tips for Living Well with COPD flyer offer important health and safety information for people with COPD. As part of the CIRCLES program, participants received copies of these tools to use on a daily basis. Learn more about how these tools can help you to feel better and stay healthy.

The CIRCLES Project: Activity and Exercise

The CIRCLES Project: Activity and Exercise

Activity and exercise are helpful tools for improving the quality of life of individuals with COPD. Find out how to add exercise and activity into your daily routine, and discover why exercise is such an important part of COPD management.

The CIRCLES Project: Medication Management

The CIRCLES Project: Medication Management

Using medications correctly is an essential part of managing your COPD. Join the COPD Foundation's CIRCLE Project as we learn more about different types of medications and how to use them correctly.

CIRCLES II Materials for Download

For more information on the CIRCLES program, email