A randomized feasibility trial published suggests that a structured singing program delivered after pulmonary rehabilitation is practical and acceptable for patients with chronic respiratory disease and could support a future large-scale clinical trial.
Pulmonary rehabilitation (PR) is considered a gold standard treatment for people with chronic respiratory disease, improving symptoms, exercise capacity, and quality of life. However, its benefits often diminish following program completion. Investigators examined whether a 12-week “singing for lung health” program could serve as a maintenance strategy following PR and whether a full-scale randomized controlled trial (RCT) would be feasible.
The multicenter, assessor-blinded feasibility study, published in BMJ Open Respiratory Research, enrolled participants from four London PR centers between October 2022 and November 2023. Of 1,311 patients assessed for PR, 838 completed the program. Among those, 243 were ineligible for the study and 531 declined participation. Ultimately, 64 participants were randomized to usual care or to weekly singing for lung health (SLH) sessions for 12 weeks, according to the study.
“A definitive [randomized] controlled trial of SLH post-PR appears feasible, with acceptable uptake and completion rates,” the authors wrote. “It is feasible to conduct an RCT investigating the clinical and cost-effectiveness of a 12-week SLH post-PR maintenance [program] compared with usual care.”
Feasibility benchmarks were largely met. Of 32 participants assigned to SLH, 20 (63%) attended at least eight of 12 sessions, exceeding the prespecified adherence threshold of 60%. Overall, 59 of 64 participants (92%) completed the 12-week follow-up assessment, and there was no greater attrition in the control group.
Participants had a mean age of 69 (12) years. Diagnoses included chronic obstructive pulmonary disease, asthma, interstitial lung disease), and bronchiectasis. All PR centers successfully incorporated an SLH “taster session” into their education programs prior to recruitment.
Although the study was not powered to assess efficacy, exploratory analyses suggested potential signals of benefit. Effect sizes greater than 0.4 were observed for Short Physical Performance Battery scores, lung function measures, and physical activity among participants with asthma or chronic obstructive pulmonary disease.
No safety concerns related to the intervention were identified. There were 53 adverse events and 18 serious adverse events in the control group, compared with 50 adverse events and 8 serious adverse events in the SLH group, including no deaths. All serious adverse events were deemed unrelated to the intervention, according to the authors.
Qualitative interviews with patients, PR clinicians, and singing leaders indicated strong support for a larger trial. Themes included the perceived value of participation, the social benefits of group singing, and suggestions to improve recruitment and data collection processes.
The investigators also acknowledged operational challenges, including high screening requirements, variable recruitment rates across sites, and incomplete home exercise diary returns. They recommended dedicated principal investigators at each site and refinements to outcome measures for a future study.
Overall, the results suggest a larger trial is warranted to see whether singing for lung health can help people maintain the benefits they gain from pulmonary rehabilitation, while also providing an engaging, group-based option for ongoing support.
Source: BMJ Journals
