The number of people with lasting symptoms of COVID-19 continues to rise and it is estimated that 1·5 million people have lasting symptoms of COVID-19 in the UK alone.
Up to 25% of individuals admitted to hospital with COVID-19 felt they needed rehabilitation, although the proportion of non-hospitalised patients requiring support for symptoms is intangible.
,
The need for rehabilitation causes a huge demand on current and emerging services in the context of the ongoing impacts of COVID-19 on service provisions. Considering this, there is a huge need for a variety of flexible interventions to improve the lasting symptoms of COVID-19.
report their findings from a randomised controlled trial of an online wellbeing and breathing programme (English National Opera [ENO] Breathe), developed by the ENO learning and participation team alongside clinicians. This programme focuses on breathing retraining using singing techniques, and is delivered via an online platform. This is the first study to explore a singing-based intervention for individuals with lasting symptoms of COVID-19. The provision and implementation of singing techniques for breathlessness vary but are largely provided by charities and support groups and not as part of routine health care. Singing techniques have demonstrated improvements in conditions such as chronic obstructive pulmonary disease (COPD) for health-related quality of life and exercise capacity, and the evidence for this is increasing.
,
Philip and colleagues
found improvements in elements of breathlessness and mental wellbeing for individuals with breathlessness following SARS-CoV-2 infection and, as a result, suggest that ENO Breathe provides a flexible and suitable strategy for managing some of the lasting symptoms of COVID-19. Access to this intervention can provide health-care professionals with a useful tool to aid recovery and can supplement routine care.
Interestingly, in Philip and colleagues' study, breathlessness did not significantly improve between groups using the dyspnoea-12 or visual analogue scale (VAS) for rest and walking, but did demonstrate improvements in the VAS running score. It is possible that this was a result of the participants' interpretation of the question and the recall required to interpret their breathlessness experiences. Breathlessness is a complex symptom that is difficult to quantify and is influenced by physiology, psychology, and social circumstances. The relative contribution of these influences can vary and, therefore, breathlessness can be difficult to measure in a quantitative manner.
Breathlessness can manifest as different sensations, which are in part captured by the dyspnoea-12, and it is possible that interventions target a specific sensation or influencing factor, which might explain the variability in responses to interventions. Philip and colleagues stipulate that this intervention might require considerations to patient selection and that further research should explore the characteristics that result in a favourable outcome to tailor interventions suitably, alongside patient preferences.
The key message from Philip and colleagues' study is that the ENO Breathe intervention can improve mental wellbeing and elements of breathlessness. The authors provide a novel intervention that can be added to the breathlessness toolbox in the treatment of COVID-19 symptoms and beyond. Further evidence to support other interventions in the treatment and management of COVID-19 symptoms is essential and would add to the suite of options for health-care professionals, which would have a positive effect on service provision.
I declare no competing interests.
Table of Contents
References
- 1.
Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study.
Lancet Respir Med. 2021; 9: 1275-1287
- 2.
Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK.
- 3.
Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK.
- 4.
The demand for rehabilitation following COVID-19: a call to service providers.
Physiotherapy. 2021; 113: A1-A3
- 5.
An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial.
Lancet Respir Med. 2022; ()
- 6.
UK feasibility study on the value of singing for people with chronic obstructive pulmonary disease (COPD) September 2011 to June 2012.
Eur J Public Health. 2013; 23: 170
- 7.
Use of singing for lung health as an alternative training modality within pulmonary rehabilitation for COPD: an RCT.
Eur Respir J. 2021; ()
- 8.
The physiology of singing and implications for ‘Singing for Lung Health’ as a therapy for individuals with chronic obstructive pulmonary disease.
BMJ Open Respir Res. 2021; 8e000996
- 9.
Managing breathlessness: a palliative care approach.
Postgrad Med J. 2016; 92: 393-400
Article Info
Publication History
Published: April 27, 2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
