Carol Singers (CC BY 2.0)
In this post, Dr Nicholas Hopkinson looks at the benefits of singing for people with respiratory conditions such as COPD.
Singing carols is a big part of Christmas cheer, but not many people realise that singing can also be helpful for people with lung disease. COPD is an extremely common condition – there are 1.3 million people with this diagnosis in the UK. Existing treatments help to some extent, but do not reverse the underlying pathology, meaning that even with optimal care many patients remain breathless with activity limitation and poor quality of life. This symptom burden represents a major area of unmet need. Singing for Lung Health (SLH) groups are a potential way for patients to gain skills to improve control of their breathing and posture, reducing symptom burden and enhancing wellbeing.
What is singing for lung health?
Singing for lung health involves taking part in classes led by a specially trained singing teacher. Patients learn techniques to help control their breathing and posture as part of a group activity which is fun and sociable. The goal for the groups is to get better at singing, an artistic objective. By doing this individuals gain skills that help them to cope with their lung condition, a health improvement objective. The classes have a particular focus on activities and exercises that are helpful for people with lung disease and so differ from more generic “singing for well-being” groups.
Singing for lung health has grown from a few small clinical trials to more than 80 groups nationally. As well as the plausibility of an approach based on learning to control the breath in people with lung disease, singing is also a fun social activity. Results from the Royal College of Physicians COPD audit show that provision of pulmonary rehabilitation is still limited, so there is a need for activities to sustain the physical and social benefits that these produce once people have completed them. For some people, taking part in a singing group may be a useful stepping stone to agreeing to join a formal rehabilitation program.
What’s the evidence?
The current evidence base for SLH has been set out in a systematic review and consensus statement. We know from research that people taking part in the groups find them enjoyable and helpful but there have only been small, short-term studies so far to assess its clinical effectiveness. In the first, a six-week course of twice-weekly lessons improved SF-36 compared to usual care. In the second, eight-week study, where the control group took part in a film discussion group, the mental component score of the SF-36 improved in both arms but the physical component improved only in the SLH group. Qualitative data, based on interviews and questionnaires shows that participants value participation in SLH and feel that it benefits them physically in terms of breathing control and confidence. Typical responses included:
“The exercises, thinking about breathing and relaxing when I have (breathing) problems….this has been very useful”
“Walking better, I go out more”
“Now things are less of a chore, housework is no longer a struggle”.
How can patients take part?
The British Lung Foundation currently runs a programme that involves training singing teachers and establishing classes throughout the UK. The BLF website has a tool for patients to find local singing groups as well as local Breathe Easy groups.
Dr Nicholas Hopkinson (@COPDdoc) is a Reader in Respiratory Medicine at Imperial’s National Heart and Lung Institute as well as an Honorary Consultant Chest Physician at The Royal Brompton Hospital.