Did a Singing-Based Program Hit the Right Notes for Long COVID Patients?

An online singing-based program from the English National Opera (ENO) was associated with improvements in quality of life among adults with long COVID, a pragmatic randomized trial in England showed.

Compared with usual care, the 6-week ENO Breathe program was associated with improvements in mental health composite scores on the RAND 36-item short form survey instrument (SF-36; regression coefficient 2.42, 95% CI 0.03-4.80, P=0.047) and on the visual analog scale for breathlessness-running (-10.48, 95% CI -17.23 to -3.73, P=0.0026), reported Keir Philip, MRCP, of Imperial College London, and colleagues.

However, there were no significant differences in the physical health composite scores (regression coefficient 0.60, 95% CI -1.33 to 2.52, P=0.54), nor any of the individual SF-36 subscales, they noted in Lancet Respiratory Medicine.

Since music and singing-based activities have been shown to “improve health-related quality of life … and are popular for people with long-term respiratory conditions and breathlessness,” the ENO Breathe program was developed with healthcare professionals to support patients recovering from long COVID, the authors explained.

This was the first study to explore a singing-based intervention for individuals with long COVID, noted Enya Daynes, MSc, of University Hospitals of Leicester in England, in an accompanying editorial. The study results “suggest ENO Breathe provides a flexible and suitable strategy for managing some long COVID symptoms.”

However, she also pointed to some caveats, namely that a singing-based program would likely not appeal to all patients, and that “its benefit and safety in individuals without screening are unknown.”

Daynes also noted that breathlessness did not significantly improve between groups using the Dyspnea-12 questionnaire or the visual analog scale for walking, which might have been due to how participants interpreted the question of breathlessness.

“Breathlessness is a complex symptom that is difficult to quantify and is influenced by physiology, psychology, and social circumstances,” she wrote. “It is possible that interventions target a specific sensation or influencing factor, which might explain the variability in responses to interventions.”

For this randomized trial, Philip and team included adults with ongoing breathlessness, with or without anxiety, who had been referred from any of the 51 long COVID clinics in the U.K.

Long COVID was defined as ongoing symptoms for at least 4 weeks following illness, and was diagnosed by a specialist based on a combination of laboratory and clinical factors.

From April 22 to May 25, 2021, 74 participants were randomized to the intervention and 76 to usual care. Across both groups, mean age was 49, 81% were women, and there was a mean of 320 days from COVID symptom onset to randomization.

ENO Breathe consisted of online sessions focused “on breathing retraining through singing techniques and lullabies, delivered online via a video conferencing application.” Participants received emails with new music and supportive content, and had access to resources to support learning between sessions, the authors said.

The usual care group received clinical management from their COVID clinic, and went on to take part in ENO Breathe after they exited the trial.

Philip’s group concluded that the program appeared “safe and effective,” at least in improving mental health and elements of breathlessness for certain patients with long COVID, noting that additional research is needed to determine who might most benefit from the intervention.

“This study suggests mind-body interventions targeting health-related quality of life could have a potential role as complementary additional elements of long COVID management,” they wrote.