Aussie researchers trial singing as COPD treatment


By Geir O'Rourke

22 Aug 2022

Australian researchers are recruiting patients to join online choirs as part of a study into the potential benefits of singing on COPD and other lung diseases.

At least 140 patients with COPD, ILD and breathlessness are being sought for the trial, which will test whether singing can lead to improvements in health-related quality of life compared to usual care.

Those in the intervention arm will be enrolled into weekly 90-minute group sessions held over Zoom, with participants encouraged to suggest songs and focus on breathing control.

The idea is to offer a low-cost and accessible alternative to regular pulmonary rehabilitation (PR) programs, says the research team led by Associate Professor Natasha Smallwood of the Alfred Hospital and Monash University in Melbourne.

Writing in Respiratory Research (link here), they stress PR — which encompasses tailored exercise, breath training, counselling and education — is well established and has been shown to improve symptoms and function.

But despite these benefits, PR referral and completion rates in Australia are “alarmingly low”.

Associate Professor Natasha Smallwood

“Of the nearly 1.5 million older Australians living with symptomatic COPD, fewer than 10% have ever accessed a program; and internationally fewer than 3% have accessed pulmonary rehabilitation after hospitalisation for an exacerbation of their disease,” they wrote in the study protocol published last week.

“Given these challenges, there is a need for sustainable, novel, community-based interventions that are acceptable to patients and their carers, and effective in reducing symptom burden.”

They added that group singing was a low-cost and risk activity, with previous trials conducted overseas reporting improvements to anxiety and depression, exercise tolerance and overall quality of life.

However, those trials had often been limited by low study numbers and a high risk of bias, while none had included patients with ILD, nor had any been conducted in Australia, the authors said.

Called SINFONIA (benefits of SingINg FOr breathing in COPD aNd ILD pAtients), the trial would have another difference compared with most existing studies because its singing groups would meet online, a necessity brought about by the COVID-19 pandemic.

Looking on the bright side, the authors added: “Nevertheless, online delivery represents an attractive opportunity to improve healthcare access for participants with limited mobility, poor health, or who live in a rural location with limited access to health services.”

“This is particularly relevant in Australia, where a third of the population lives in regional or remote areas with reduced service availability despite chronic respiratory disease being overrepresented amongst this group.”

Phase II would determine the feasibility and acceptability of the intervention, while phase III would measure its effect on quality of life with a 36-item short form survey at 12 weeks.

Participants would be recruited from tertiary respiratory care clinics based at the Alfred Hospital, Austin Health, Royal Melbourne Hospital, and St Vincent’s Hospital in Melbourne, Australia, however others could self-refer or be referred by their primary care provider, the authors said.

Eligibility would be open to adults with confirmed COPD or ILD, on stable treatment for at least four weeks at time of recruitment, with a modified Medical Research Council (mMRC) dyspnoea score of two or greater.

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