The physiology of singing and implications for ‘Singing for Lung Health’ as a therapy for individuals with chronic obstructive pulmonary disease

Abstract

Singing is an increasingly popular activity for people with chronic obstructive pulmonary disease (COPD). Research to date suggests that ‘Singing for Lung Health’ may improve various health measures, including health-related quality-of-life. Singing and breathing are closely linked processes affecting one another. In this narrative review, we explore the physiological rationale for ‘Singing for Lung Health’ as an intervention, focusing on the abnormalities of pulmonary mechanics seen in COPD and how these might be impacted by singing. The potential beneficial physiological mechanisms outlined here require further in-depth evaluation.

Physiological changes related to 10 weeks of singing for lung health in patients with COPD

“… 20 36 41 44 However, specific physiological changes have not been convincingly confirmed. 2 4 20 42 In accordance with formerly posed requests, 2 the present study explored whether SLH might be associated with change in any detectable physiological parameters specifically focusing on measures reflecting lung function, inspiratory muscle strength and control, dyspnoea and breathing control, and exercise-induced changes in pulse and saturation.…”

“…The recent narrative review 2 suggested that singing may improve aspects in breathing pattern, respiratory control, hyperinflation, dyspnoea, health-related QoL, and interoception. Improved physical capacity and activity has likewise been reported in some previous studies besides enhanced respiratory well-being.…”

“…However, it is still unknown how singing exerts its effects, that is, which specific physiological parameters may change during an effective singing training course. 2–4 A recent narrative review 2 suggested that singing may improve aspects in breathing pattern, respiratory control, hyperinflation, dyspnoea, health-related QoL, interoception, and physical capacity and activity in COPD. However, the authors concluded that the present evidence suffers from severe between-study heterogeneity including definitions and parameters of effectiveness.…”

“… 21 22 In contrast, the primary outcome of the majority of studies on singing is perceived effect (qualitative or semiquantitative outcomes) and not objective parameters such as exercise capacity and physiological mechanisms. 2–4 12 Thus, there is a lack of research on physiological changes during singing and on the association between achieving objective and subjective improvement.…”

Treating COVID-19-related breathlessness with novel interventions

“…The theoretical premise for the effect of singing on breathlessness has been explored in the context of COPD and can result in altered breathing mechanics. 8 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.…”