Breathing techniques contributed to COVID-19 recovery

COVID-19 patients often deal with breathlessness, anxiety, and fatigue persisting months after the acute infection. Online programmes for teaching breathing techniques are feasible. Two home-based rehabilitation tools that contributed significantly to recovery were presented in 2 studies. Both inspiratory muscle training (IMT) and opera singing helped to reduce dyspnoea in rehabilitation after COVID-19.

The recovery of COVID-19 is associated with prolonged symptoms, including breathlessness. Some patients even report breathlessness for more than 1 year after the acute infection so there is an urgent need for identifying rehabilitation strategies. Prof. Melitta McNarry (Swansea University, UK) and colleagues therefore investigated the role of IMT in COVID-19 recovery [1]. In addition, The English National Opera (ENO) conducted an online programme, which is not a singing group, but an intervention that uses singing techniques to aid recovery from COVID-19 [2].

In the IMT programme, adults recovering from self-reported COVID-19 were included in the study. Shortness of breath was the primary inclusion criteria. A total of 250 participants (median age 48 years) were randomised 4:1 to the IMT programme or the control group. The intervention group followed IMT sessions 3 times per week for an 8-week period at 80% maximal capacity. The sessions took place remotely through Zoom. At baseline and post-intervention, breathlessness (King’s Brief Interstitial Lung Disease [KBILD] Questionnaire), respiratory muscle strength, fitness (Chester Step Test), and physical activity were assessed.

Results showed that IMT improved all domains of the KBILD; dyspnoea was significantly reduced by 33% (P<0.001). Significant improvements were also obtained in maximal inspiratory pressure, fatigue index, and fitness (all P<0.001). However, no improvement on physical activity nor on sleep was observed.

For the ENO programme, the ENO and an NHS trust collaborated to create ENO Breath: a 6-week online programme teaching breathing techniques and lullabies to COVID-19 patients. A pilot of ENO Breath was run for people with persistent dyspnoea at outpatient follow-up, >8 weeks after hospital discharge. Patients with persistent dyspnoea post-acute illness were encouraged by clinical staff to self-refer to ENO Breath, provided they met the following medical criteria: normal chest radiology, normal resting and exertional SpO₂, normal basic blood tests, and optimised pre-existing respiratory or cardiology comorbidities. Patients completed pre- and post-programme questionnaires about dyspnoea (visual analogue scale 0–10), anxiety (GAD7), and wellbeing (RAND36). Participants’ views were discussed in focus groups and post-programme written surveys.

During ENO Breath pilot, 135 participants with a mean age of 47 years completed the programme. Of these, 17 (13%) had been hospitalised due to COVID-19. Online attendance was high with participants attending an average of 5.5 out of 6 sessions (91%). After following ENO Breath, 112 (83%) participants reported improved dyspnoea over the 6 weeks. Moreover, a significant improvement in anxiety was observed: GAD7 went from 6 to 4 (P<0.001). Additionally, an improvement in social functioning (11%), energy and fatigue (8%), and physical functioning (8%) was seen. Patients described their experience as enjoyable, calming, and a useful distraction from their breathing. The breathing techniques helped participants to better cope with their daily symptoms. In addition, group sessions combatted loneliness and allowed for patients to connect with people in similar situations.

Both IMT and opera singing contributed to recovery following COVID-19. Only a limited number of sessions per week showed a clear improvement on symptoms as breathlessness, anxiety, and fatigue. Overall, both tools are acceptable and feasible for rehabilitation and should be considered for wider implementation.

1. McNarry M, et al. Late Breaking Abstract - A randomised control trial using inspiratory muscle training in post-COVID-19 rehabilitation. Abstract 169. ERS 2021, 5–8 September.
2. Owles H, et al. ENO breathe: An arts and health alliance to help COVID-19 recovery. Abstract 457. ERS 2021, 5–8 September.

 

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Posted on 9 November 2021