An interesting paper published in The Lancet by Philip and others 27th April 2022 looked into this issue.

There are few evidence based interventions for long COVID, however, holistic approaches supporting recovery are advocated, this study assessed whether an online breathing and wellbeing programme improved the health-related quality of life in people with persistent breathlessness following COVID-19.

The study conducted a parallel-group, single-blind, randomised controlled trial in patients who had been referred from one of 51 UK-based collaborating long COVID clinics.

Eligible participants were:

  • Aged 18 years or older
  • Recovering from COVID-19 with ongoing breathlessness
  • With or without anxiety, at least four weeks after symptom onset
  • Had internet access with an appropriate device
  • Deemed clinically suitable for participation by one of the collaborating COVID-19 clinics.

Following clinical assessment, potential participants were given a unique online portal code.

Participants were randomly assigned to either immediate participation in the English National Opera Breathe programme or to usual care.

Randomisation was done by the research team using computer-generated block randomisation lists, with block size 10.

The researcher responsible for randomisation was masked to responses.

Participants in the ENO Breathe group participated in a six-week online breathing and wellbeing programme, this had been developed for people with long COVID experiencing breathlessness, focusing on breathing retraining using singing techniques.

Those in the deferred group received usual care until they exited the trial.

The primary outcome was assessed as changes in the health related quality of life and this was assessed using a questionnaire survey instrument with both mental and physical scores.

Secondary outcome measures were the chronic obstructive pulmonary disease assessment test score, visual analogue scales for breathlessness and scores on the dyspnoea 12, the generalised anxiety disorder 7-item scale and the short form-6D.

Between April 22nd and May 25th 2021, 158 participants were recruited and randomly assigned.

Of these, eight were excluded but 150 participants were allocated a treatment group, 74 in the ENO Breathe group and 76 in the usual care group.

The ENO Breathe group was associated with an improvement in mental health score but not physical health score.

The VAS breathlessness score favoured the ENO Breathe participation group.

There were no other statistically significant between-group differences in secondary outcomes observed.
Analysis of the ENO Breathe participant experience identified three key themes:

  • Improvements in symptoms
  • Feeling that the programme was complementary to standard care
  • The particular suitability of singing and music to address their needs.

The findings suggested that an online breathing and wellbeing programme can improved the mental component and some elements and breathlessness in people with persisting symptoms after COVID-19.

Mind–body and music-based approaches, including practical, enjoyable, symptom-management techniques might have a role in supporting recovery in those with breathlessness during long COVID.

Dr Paul Ettlinger

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