Physiological changes related to 10 weeks of singing for lung health in patients with COPD

Abstract

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.

Effect of Singing on Symptoms in Stable COPD: A Systematic Review and Meta-Analysis

“…[35][36][37][38] Singing is mainly characterized by pursed-lips and diaphragmatic breathing. Pursed-lips breathing is widely used in pulmonary rehabilitation programmes in order to impose positive expiratory pressure, with the aim of creating resistance to expiratory flow and preventing early bronchial collapse, 39,40 and conscious use of the diaphragm during respiration increases lung capacity. 41 Meanwhile, Bonilha's study proved that singing significantly improved respiratory muscle (PE max ), and respiratory muscle is closely related to the lung function of patients with COPD, 40,42 suggesting the effectiveness of singing in improving lung function.…”

Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol

“…23 Music therapy simultaneously targets physiological and psychological changes to help improve control of breathing. [24][25][26][27] SLH has been shown to be beneficial at improving the quality of life and perceived breathing control of patients with chronic obstructive pulmonary disease in a UK-wide service evaluation, and in studies with comparison groups receiving no active intervention, or alternative group social interaction in chronic obstructive pulmonary disease (COPD). 23 28-30 Fortyseven per cent of individuals with COPD have secondary BPD.…”

“…Singing for Lung Heath (SLH) is an intervention designed to enable people with chronic respiratory disease to use singing exercises and repertoire to enable them to manage their symptoms 23. Music therapy simultaneously targets physiological and psychological changes to help improve control of breathing 24–27. SLH has been shown to be beneficial at improving the quality of life and perceived breathing control of patients with chronic obstructive pulmonary disease in a UK-wide service evaluation, and in studies with comparison groups receiving no active intervention, or alternative group social interaction in chronic obstructive pulmonary disease (COPD) 23 28–30.…”

The impact of music therapy in the rehabilitation of individuals with COPD: systematic review

“…Chronic Obstructive Pulmonary Disease (COPD) affects individuals and countries as socioeconomically and ranks third among the causes of morbidity (1,2). COPD impairs the respiratory functions and oxygenation of individuals by causing irreversible airway limitation.…”

“…COPD impairs the respiratory functions and oxygenation of individuals by causing irreversible airway limitation. Airway limitation, which causes dyspnea, cough, sputum, fatigue, and anxiety symptoms, negatively affect the daily life activities of individuals (1,2,3). The symptoms experienced in COPD can be reduced by pulmonary rehabilitation (PR), and it has a positive effect on the respiratory functions and quality of life of the individual (1,2,3,4).…”