Specialised singing programmes can improve the symptoms and quality of life of people with lung disease

Singing can improve the quality of life of people with lung disease and help reduce their symptoms, according to a gold-standard randomised-controlled trial presented at the European Respiratory Society Congress in Amsterdam, the Netherlands [1].

The study was presented by Professor Natasha Smallwood from Monash University, Melbourne, Australia.

Professor Smallwood told the Congress: “Chronic breathlessness is a common and highly distressing symptom for people with chronic obstructive pulmonary disease and interstitial lung disease. Yet there is a lack of safe, effective, and acceptable treatment options for managing this symptom.

“Group singing is increasingly used to manage symptoms and improve quality of life for people with neurological, mental health, and respiratory conditions, but we need more evidence to prove that this is beneficial, especially for people with interstitial lung disease.”

Interstitial lung disease (ILD) is a general term for a large group of conditions that cause progressive scarring and inflammation of the lung tissue affecting hundreds of thousands of people around world. Chronic obstructive pulmonary disease (COPD) is a serious lung condition affecting around 400 million people worldwide.

The SINFONIA study saw patients take part in a 90-minute online group singing session delivered once a week for 12 weeks over Zoom. The content of the SINFONIA sessions was developed and delivered by a registered music therapist and included dedicated time for warmups, breathing exercises, song singing, and social check ins to foster group connection.

The programme was delivered online to make it as easy as possible to take part, and patients were loaned iPads and given free data plans to help reduce barriers to participation. The group sang songs such as ‘Can’t Help Falling In Love’, ‘Let It Be’, and ‘Pack Up Your Troubles’.

Of the 101 participants, 50 were allocated to the singing sessions and 51 to a group who were given usual care (for example smoking cessation, respiratory vaccines, inhaler therapy, self-management education, and anti-fibrotic medications).

Sixty-four of the patients had chronic obstructive pulmonary disease (COPD), and 37 had interstitial lung disease (ILD).

Patients completed a questionnaire called the SF-36, which records their quality of life across eight sub domains (including pain, social functional, general health and fatigue). These domains are rated from 0 (worst quality of life) to 100 (best quality of life) and then averaged to give a total score.

SF-36 was 7.4 points higher in the singing group compared to the control group.

Professor Smallwood explained: “Compared to usual care, taking part in the SINFONIA singing programme led to improved quality of life for people with chronic obstructive pulmonary disease or interstitial lung disease with chronic breathlessness. These effects were most pronounced amongst people who attended at least 8 of the 12 sessions.

“We saw the greatest improvements in the domains that measured limitations due to physical health or emotional problems,” she adds.

There was also some evidence to suggest that women, people with anxiety or depression, and those who have not previously completed pulmonary rehabilitation experienced the greatest improvements in quality of life as a result of taking part in the online group singing programme.

“The way in which group singing improves quality of life remains unclear and may vary for different participants,” Professor Smallwood added. “But it could be due to better control of breathing, social connection, or mood improvements.”

Dr Apostolos Bossios, Head of the European Respiratory Society’s expert group on airway diseases, asthma, COPD and chronic cough, based at the at Karolinska Institutet, Sweden, who was not involved in the research said: “People with COPD and ILD suffer with long-term breathing difficulties, and this can severely restrict their day to day lives. These conditions cannot be cured, so we need better strategies to help people live happier, healthier lives.

“The world-first SINFONIA study adds to a growing body of evidence that supports using non-medication-based approaches for managing challenging conditions.

“By better understanding how group singing can be incorporated in existing healthcare services, we will be able to make a difference in the lives of patients with lung disease such as COPD and ILD.”

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