BackgroundPulmonary rehabilitation (PR) is a cornerstone in Chronic Obstructive Pulmonary Disease (COPD) management. However, PR adherence is generally low, and barriers include availability, economic issues, motivation, and inability to attend or perform physical training. Therefore, alternative, evidence-based PR activities are required. Singing may have benefits within quality of life (QoL), respiratory control, and wellbeing in COPD, but impact on PR key outcome, physical exercise capacity, is uncertain.MethodsIn this RCT (NCT03280355), we investigated effectiveness of 10-weeks of PR, including either “Singing for Lung Health” (SLH)-training or standard physical exercise training (PExT). Primary outcome: Change in exercise capacity (6-Minute Walk Test, distance (6 MWD)) from baseline to post-PR. Secondary outcomes: Changes in QoL (St George's Respiratory Questionnaire (SGRQ)), Hospital anxiety and depression score (HADS), lung function, dyspnoea, and adherence.ResultsWe included 270 COPD patients, and 195 completed the study. Demographics across groups were comparable, and both groups improved significantly in 6 MWD and SGRQ. SLH was non-inferior to PExT in 6 MWD (13.1 m±36.3/14.1 m±32.3; p=0.81 [95%CI=−7.28;9.30]) with 21.8% respectively 25.0% (p=0.57) reaching 6 MWD Minimal Important Difference of 30 m. We found no significant between-group differences concerning SGRQ, HADS, lung function, dyspnoea, or adherence.ConclusionsOur study suggests that SLH is non-inferior to PExT in improving 6 MWD during a 10-weeks PR programme. Future studies addressing reproducibility, long-term effects and health-economics are needed.
ObjectivesSinging is considered a beneficial leisure time intervention for people with respiratory diseases, and lung choirs have gained increasing attention. However, there is no available guideline on preferred methodology, and hence, outcomes, delivery, and benefits are unclear. The present study investigated for the first time ever emerged delivery, approach, and experiences in Danish lung choirs and their singing leaders, hypothesising the array to be heterogeneous, without disease-specific approach, and a challenging field to navigate for the singing leaders.SettingAn online survey comprising 25 questions was performed individually, May 2017, in Denmark.ParticipantsCurrent singing leaders of Danish lung choirs, identified by hand searches on the internet. In total, 33 singing leaders in formal and informal settings were identified and 20 (67%) responded.Primary and secondary outcome measuresDistribution in content, delivery, and approach; level of disease-specific knowledge and modification; experience of challenges and benefits. Quantitative variables were counted, and an inductive content analysis approach was used for the qualitative study component.ResultsThe lung choirs were heterogeneous concerning setting, duration, and content. The approach was traditional without disease-specific content or physical activity. Most singing leaders held various academic degrees in music, but lacked skills in lung diseases. However, they experienced lung choirs as a highly meaningful activity, and reported that participants benefited both musically, psychosocially, and physically. Singing leaders were enthusiastic regarding potentials in the ‘arts-and-health’ cross-field and experienced an expansion of their role and overall purpose, professionally as well as personally. However, they also experienced insecurity, inadequacy, and isolation, and requested methodological guidelines, formal support, and peer network.ConclusionDanish lung choirs are led without any disease-specific guideline or methodological approach. Further studies are needed to develop and distribute a preferred methodological approach.Trial registration numberThis study is linked to clinical trial number NCT03280355 and was performed prior to data collection and results of the clinical trial
BackgroundSinging for Lung Health (SLH) was non-inferior to physical exercise training in improving 6-minute walking test distance (6MWD) and quality of life (St. George’s Respiratory Questionnaire (SGRQ)) within a 10-week pulmonary rehabilitation (PR) programme for COPD in our recent randomised controlled trial (RCT) (NCT03280355). Previous studies suggest that singing improves lung function, respiratory control and dyspnoea, however this has not yet been convincingly confirmed. Therefore, this study aimed to explore the impact of SLH on physiological parameters and the associations with achieving the minimal important difference (MID) in 6MWD and/or SGRQ.MethodsWe conducted post hoc, per-protocol analyses mainly of the SLH group of the RCT, exploring associations with 6MWD and SGRQ results by stratifying into achieving versus not-achieving 6MWD-MID (≥30 m) and SGRQ-MID (≤−4 points): changes in lung function, inspiratory muscle strength/control, dyspnoea, and heart rate response using logistic regression models. Further, we explored correlation and association in achieving both 6MWD-MID and SGRQ-MID (or in neither/nor) using Cohen’s κ and Cochran-Mantel-Haenszel Test.ResultsIn the SLH study group (n=108), 6MWD-MID was achieved by 31/108 (29%) and in SGRQ by 53/108 (49%). Baseline factors associated with achieving MID in either outcome included short baseline 6MWD and high body mass index. Achieving 6MWD-MID was correlated with improved heart rate response (OR: 3.14; p=0.03) and achieving SGRQ-MID was correlated with improved maximal inspiratory pressure (OR: 4.35; p=0.04). Neither outcome was correlated with significant spirometric changes. Agreement in achieving both 6MWD-MID and SGRQ-MID was surprisingly insignificant.ConclusionsThis explorative post hoc study suggests that SLH is associated with physiological changes after short-term PR for COPD. Future physiological studies will help us to understand the mechanisms of singing in COPD. Our study furthermore raises concern about poor agreement between subjective and objective benefits of PR despite state-of-the-art tools.
screening deoxyribonucleic acid (DNA) libraries with immune sera or with immune T-lymphocytes [10,11].This study was designed to evaluate diagnostic sensitivity and specificity of a novel tuberculosis complexspecific recombinant protein of 34 kDa [12,13]. An enzyme linked immunosorbent assay (ELISA) test using a fusion protein (MS2-34) comprising the 16 kDa NH 2terminal fragment of the 34 kDa protein and an 11 kDa fragment of the MS-2 polymerase fusion partner indicated elevated anti-34 kDa antibody levels in the sera of patients with TB. By combining this test with an ELISA using the M. tuberculosis-specific recombinant 38 kDa protein (p38) [14,15], it was possible to diagnose TB in AFB smearnegative patients with high sensitivity and specificity. Methods Production of the recombinant MS2-34 fusion proteinPartial expression of the 34 kDa antigen gene [16] was obtained as a 27 kDa fusion protein [17]. Briefly, a
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