Singing teaching as a therapy for chronic respiratory disease--a randomised controlled trial and qualitative evaluation

Victoria M Lord, Phoene Cave, Victoria J Hume, Elizabeth J Flude, Amanda Evans, Julia L Kelly, Michael I Polkey, Nicholas S Hopkinson, Victoria M Lord, Phoene Cave, Victoria J Hume, Elizabeth J Flude, Amanda Evans, Julia L Kelly, Michael I Polkey, Nicholas S Hopkinson

Abstract

Background: Despite optimal pharmacological therapy and pulmonary rehabilitation, patients with COPD continue to be breathless. There is a need to develop additional strategies to alleviate symptoms. Learning to sing requires control of breathing and posture and might have benefits that translate into daily life.

Methods: To test this hypothesis we performed a randomised controlled trial, comparing a six week course of twice weekly singing classes to usual care, in 28 COPD patients. The experience of singing was assessed in a qualitative fashion, through interviews with a psychologist. In addition, we surveyed patients with chronic respiratory conditions who participated in a series of open singing workshops.

Results: In the RCT, the physical component score of the SF36 improved in the singers (n = 15) compared to the controls (n = 13); +7.5(14.6) vs. -3.8(8.4) p = 0.02. Singers also had a significant fall in HAD anxiety score; -1.1(2.7) vs. +0.8(1.7) p = 0.03. Singing did not improve single breath counting, breath hold time or shuttle walk distance. In the qualitative element, 8 patients from the singing group were interviewed. Positive effects on physical sensation, general well-being, community/social support and achievement/efficacy emerged as common themes. 150 participants in open workshops completed a questionnaire. 96% rated the workshops as "very enjoyable" and 98% thought the workshop had taught them something about breathing in a different way. 81% of attendees felt a "marked physical difference" after the workshop.

Conclusion: Singing classes can improve quality of life measures and anxiety and are viewed as a very positive experience by patients with respiratory disease; no adverse consequences of participation were observed.

Trial registration: Current Controlled Trials--ISRCTN17544114.

Figures

Figure 1
Figure 1
CONSORT Flow Diagram.

References

    1. Celli BR, MacNee W, Agusti A, Anzueto A, Berg B, Buist AS, Calverley PMA, Chavannes N, Dillard T, Fahy B. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–946. doi: 10.1183/09031936.04.00014304.
    1. Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, Carone M, Celli B, Engelen M, Fahy B. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–1413. doi: 10.1164/rccm.200508-1211ST.
    1. Calverley PM, Koulouris NG. Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology. Eur Respir J. 2005;25:186–199. doi: 10.1183/09031936.04.00113204.
    1. O'Donnell DE, Bertley JC, Chau LK, Webb KA. Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms. Am J Respir Crit Care Med. 1997;155:109–115.
    1. Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev. 2008. p. CD005623.
    1. Garrod R, Dallimore K, Cook J, Davies V, Quade K. An evaluation of the acute impact of pursed lips breathing on walking distance in nonspontaneous pursed lips breathing chronic obstructive pulmonary disease patients. Chron Respir Dis. 2005;2:67–72. doi: 10.1191/1479972305cd068oa.
    1. Dechman G, Wilson CR. Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease. Phys Ther. 2004;84:1189–1197.
    1. Pomidori LP, Campigotto FMD, Amatya TMMD, Bernardi LMD, Cogo AMD. Efficacy and Tolerability of Yoga Breathing in Patients With Chronic Obstructive Pulmonary Disease: A Pilot study. Journal of Cardiopulmonary Rehabilitation & Prevention. 2009;29:133–137.
    1. Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med. 2009;15:225–234. doi: 10.1089/acm.2008.0389.
    1. Bonilha AG, Onofre F, Vieira ML, Prado MY, Martinez JA. Effects of singing classes on pulmonary function and quality of life of COPD patients. Int J Chron Obstruct Pulmon Dis. 2009;4:1–8.
    1. Brutsche MH, Grossman P, Muller RE, Wiegand J, Pello, Baty F, Ruch W. Impact of laughter on air trapping in severe chronic obstructive lung disease. Int J Chron Obstruct Pulmon Dis. 2008;3:185–192.
    1. Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, Harvey A, Hughes T, Lincoln M, Mikelsons C. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64:i1–52. doi: 10.1136/thx.2008.110726.
    1. Lansing RW, Gracely RH, Banzett RB. The multiple dimensions of dyspnea: review and hypotheses. Respir Physiol Neurobiol. 2009;167:53–60. doi: 10.1016/j.resp.2008.07.012.
    1. Clift SM, Hancox G. The perceived benefits of singing: findings from preliminary surveys of a university college choral society. J R Soc Promot Health. 2001;121:248–256. doi: 10.1177/146642400112100409.
    1. Kenny DT, Faunce G. The impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic. J Music Ther. 2004;41:241–258.
    1. Eley R, Gorman D. Didgeridoo playing and singing to support asthma management in Aboriginal Australians. J Rural Health. 2010;26:100–104. doi: 10.1111/j.1748-0361.2009.00256.x.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research. 2002;52:69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992;145:1321–1327.
    1. Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51:903–912. doi: 10.1016/S0895-4356(98)00081-X.
    1. Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47:1019–1024. doi: 10.1136/thx.47.12.1019.
    1. Lin YC, Lally DA, Moore TO, Hong SK. Physiological and conventional breath-hold breaking points. J Appl Physiol. 1974;37:291–296.
    1. Marks B, Mitchell DG, Simelaro JP. Breath-holding in healthy and pulmonary-compromised populations: effects of hyperventilation and oxygen inspiration. J Magn Reson Imaging. 1997;7:595–597. doi: 10.1002/jmri.1880070323.
    1. Engen RL. The singer's breath: implications for treatment of persons with emphysema. J Music Ther. 2005;42:20–48.
    1. Hunter BC. Singing as a Therapeutic Agent, inThe Etude, 1891-1949. J Music Ther. 1999;36:125–143.
    1. Quint JK, Baghai-Ravary R, Donaldson GC, Wedzicha JA. Relationship between depression and exacerbations in COPD. Eur Respir J. 2008;32:53–60. doi: 10.1183/09031936.00120107.
    1. Yohannes AM, Baldwin RC, Connolly MJ. Depression and anxiety in elderly outpatients with chronic obstructive pulmonary disease: prevalence, and validation of the BASDEC screening questionnaire. Int J Geriatr Psychiatry. 2000;15:1090–1096. doi: 10.1002/1099-1166(200012)15:12<1090::AID-GPS249>;2-L.
    1. Greer TL, Trivedi MH. Exercise in the treatment of depression. Curr Psychiatry Rep. 2009;11:466–472. doi: 10.1007/s11920-009-0071-4.
    1. Giaquinto S, Cacciato A, Minasi S, Sostero E, Amanda S. Effects of music-based therapy on distress following knee arthroplasty. Br J Nurs. 2006;15:576–579.
    1. Jones AYM, Dean E, Chow CCS. Comparison of the Oxygen Cost of Breathing Exercises and Spontaneous Breathing in Patients With Stable Chronic Obstructive Pulmonary Disease. Phys Ther. 2003;83:424–431.
    1. Vitacca M, Clini E, Bianchi L, Ambrosino N. Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency. Eur Respir J. 1998;11:408–415. doi: 10.1183/09031936.98.11020408.
    1. Gosselink RA, Wagenaar RC, Rijswijk H, Sargeant AJ, Decramer ML. Diaphragmatic breathing reduces efficiency of breathing in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995;151:1136–1142.
    1. Gardiner C, Gott M, Payne S, Small N, Barnes S, Halpin D, Ruse C, Seamark D. Exploring the care needs of patients with advanced COPD: An overview of the literature. Respiratory Medicine. 2010;104:159–165. doi: 10.1016/j.rmed.2009.09.007.

Source: PubMed

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