Elkin and Philip report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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An online breathing and well-being program improved health-related quality of life and persistent breathlessness in individuals with ongoing symptoms following COVID-19, researchers reported in The Lancet Respiratory Medicine.

“We urgently need evidence-based treatments and interventions for people with long COVID, which currently affects approximately 1 in 50 people in the U.K.,” Keir E. J. Philip, MRCP, clinical research fellow at the National Heart and Lung Institute and the NIHR Imperial Biomedical Research Centre at Imperial College London, and colleagues said in a related press release. “Our study suggests that arts-in-health interventions can be effective tools for carefully selected participants, especially when successfully integrated with clinical services.”

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Philip and colleagues conducted a parallel-group, single-blind, randomized controlled trial that enrolled 150 adults referred from one of 51 U.K.-based long COVID clinics. All patients were recovering from COVID-19 with continuous breathlessness, with or without anxiety, for at least 4 weeks after symptom onset. Patients had internet access with the appropriate devices and were randomly assigned to participate in the English National Opera (ENO) Breathe program (n = 74; mean age, 49 years; 78% women) or usual care (n = 76; mean age, 50 years; 83% women).

The ENO Breathe program group participated in a 6-week online breathing and well-being program that focused on breathing retraining using singing techniques.

The primary outcome was change in health-related quality of life assessed by mental health composite and physical health composite scores. Secondary outcomes included COPD assessment test score, visual analogue scales for breathlessness and dyspnea-12, Generalized Anxiety Disorder 7-item scale and SF-6D scores. The trial was conducted from April to May 2021.

Those in the ENO Breathe program group experienced improvement in mental health composite scores (P = .047) but not physical health composite scores (P = .54) compared with usual care, according to the results. The intervention was also associated with better visual analogue scale scores for breathlessness (P = .0026).

The researchers reported no significant differences between the two groups in other secondary outcomes.

The health improvements observed in this study were further analyzed via focus groups and questionnaires. Analyses showed that individuals who participated in the ENO Breathe program reported experiencing more improvements in their symptoms, felt the program complemented other care they were receiving, and that using singing techniques and music suited their needs. Additional analyses focused on participants who completed all sessions highlighted improvements in a wider range of respiratory symptoms, anxiety and greater quality of life improvements. For example, 40% of those in the ENO Breathe group had a five-point improvement in the mental component of quality of life compared with 17% in the usual care group, according to the press release.

One participant in the ENO Breathe program group reported feeling dizzy using a computer for extended periods. No other adverse events were reported.

“As we continue to recover from the impact of the pandemic, it’s vital we find ways to support people with long COVID who are experiencing debilitating symptoms long after recovering from their initial COVID-19 infection,” Sarah Elkin, MD, consultant lead for the ENO Breathe program and respiratory consultant at the National Heart and Lung Institute at Imperial College Healthcare NHS Trust, London, said in the release. “It is extremely important to build an evidence base for programs such as ENO Breathe, so we can continue to understand how best to support people with long COVID and make improvements that can lead to better outcomes.”


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