Impact of laughter on air trapping in severe chronic obstructive lung disease

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

Figure 1

The humoristic intervention was done by Pello the clown (panel A), a professional humor consultant experienced with patients affected by chronic diseases. Panel B shows a typical scene during the humor intervention. The intervention was done in small groups with roughly 6 participants. Thus, Pello could directly interact with all participants and varied his performance in function of individual responses. The show was optimized to induce as much physical laughter as possible. Different accessories like puppets, and red plastic noses were used during the intervention, which took place on the hospital ward.

Figure 2

Effect of the humoristic intervention on total lung capacity (TLC) over a time period up to 24 hours in patients with COPD (panel A) and healthy controls (panel B). Shown are responses as partial residuals of the fitted regression model. Responders decreased their TLC for 500 mL to more than 1.55 L, which can be considered as clinically relevant. On the other hand, two individuals increased their total lung capacity by roughly 10% or 1 L over time. During the first 9 hours the patients were not allowed to inhale any medication unless used as a rescue medication (which did not occur). This might explain why some individuals increased their TLC. *Significant number of missing values for healthy controls at 24 h.

Figure 3

Comparison of the change in static lung volumes between baseline and time 0 hour after the humor intervention in TLC-responders compared to non-responders. Reduction of TLC in responders in response to the humor intervention was primarily due to a reduction of the reserve volume (RV). The functional residual capacity (FRC) and the vital capacity did not change significantly.

Figure 4

Spirogram from the real-time monitoring of the breathing pattern showing the varying instant effect of laughter on the end-expiratory lung volume (EELV) in patients with COPD. Intense laughter can lead to dynamic hyperinflation in some patients with severe COPD (panel A). Most of the times there was no significant change in the EELV due to a single fit of laughter (panel B). In some instances, particularly as a consequence of smiling, the EELV markedly diminished (panel C). Smiling was able to reduce the EELV in both COPD and controls – at least as an instant effect.