Impact of laughter on air trapping in severe chronic obstructive lung disease
Martin H Brutsche, Paul Grossman, Rebekka E Müller, Jan Wiegand, Pello, Florent Baty, Willibald Ruch, Martin H Brutsche, Paul Grossman, Rebekka E Müller, Jan Wiegand, Pello, Florent Baty, Willibald Ruch
Abstract
Static and dynamic hyperinflation is an important factor of exertional dyspnea in patients with severe COPD. This proof-of-concept intervention trial sought to study whether laughter can reduce hyperinflation through repetitive expiratory efforts in patients with severe COPD. For small groups of patients with severe COPD (n = 19) and healthy controls (n = 10) Pello the clown performed a humor intervention triggering regular laughter. Plethysmography was done before and up to 24 hours after intervention. Laughing and smiling were quantified with video-analysis. Real-time breathing pattern was assessed with the LifeShirt, and the psychological impact of the intervention was monitored with self-administered questionnaires. The intervention led to a reduction of TLC in COPD (p = 0.04), but not in controls (p = 0.9). TLC reduction was due to a decline of the residual volume. Four (22 [CI 95% 7 to 46] %) patients were > or = 10% responders. The frequency of smiling and TLC at baseline were independent predictors of TLC response. The humor intervention improved cheerfulness, but not seriousness nor bad mood. In conclusion, smiling induced by a humor intervention was able to reduce hyperinflation in patients with severe COPD. A smiling-derived breathing technique might complement pursed-lips breathing in patients with symptomatic obstruction.
Figures
References
- [ATS] American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991;144:1202–18.
- [ATS] American Thoracic Society. Standardization of Spirometry, 1994 Update American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–36.
- Brutsche MH, Downs SH, Schindler C, et al. Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA cohort study. Thorax. 2006;61:671–7.
- Calverley PM. Dynamic hyperinflation: is it worth measuring? Proc Am Thorac Soc. 2006;3:239–44.
- Ekman P, Friesen WV, Hager J. The Facial Action Coding System (FACS): A technique for the measurement of facial action. Palo Alto, CA: Consulting Psychologists Press; 2002.
- Filippelli M, Pellegrino R, Iandelli I, et al. Respiratory dynamics during laughter. J Appl Physiol. 2001;90:1441–6.
- Gelb AF, Gutierrez CA, Weisman IM, et al. Simplified detection of dynamic hyperinflation. Chest. 2004;126:1855–60.
- Gosselink R. Breathing techniques in patients with chronic obstructive pulmonary disease (COPD) Chron Respir Dis. 2004;1:163–72.
- Herxheimer H. Should asthmatic patients laugh? Lancet. 1978;2(8101):1209.
- Kimata H. Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma. Physiol Behav. 2004;81:681–4.
- Liangas G, Yates DH, Wu D, et al. Laughter-associated asthma. J Asthma. 2004;41:217–21.
- Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.
- O’Donnell DE. Ventilatory limitations in chronic obstructive pulmonary disease. Med Sci Sports Exerc. 2001;33(7 Suppl):S647–55.
- O’Donnell DE, Revill SM, Webb KA, et al. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(5):770–7.
- Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001;163:1256–76.
- Ruch W, Ekman P. The expressive pattern of laughter. In: Kaszniak AW, editor. Emotion, qualia, and consciousness. Tokyo: Word Scientific Publisher; 2001. pp. 426–43.
- Ruch W, Köhler G. The measurement of state and trait cheerfulness. In: Mervielde I, Deary I, De Fruyt F, et al., editors. Personality Psychology in Europe: Theoretical and Empirical Developments. Vol. 7. Tilburg: University Press; 1999. pp. 67–83.
- Sarafino EP, Dillon JM. Relationships among respiratory infections, triggers of attacks, and asthma severity in children. J Asthma. 1998;35:497–504.
Source: PubMed