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Abstract
Essence
An online singing-based breathing programme was linked to better quality-of-life and symptom scores in people with long COVID breathlessness.
Evidence
A UK before-after cohort study of 1,413 NHS long COVID clinic referrals found post-programme improvements in RAND-36 MHC/PHC, Dyspnoea-12, exertional breathlessness VAS, GAD-7, and CAT scores, with 1,188 (84%) providing follow-up data.
Caveat
The uncontrolled design, incomplete follow-up, and unchanged breathlessness at rest limit causal interpretation.
Simplified
BACKGROUND: Post-COVID-19 condition (also known as long COVID) breathlessness is a common, complex, and frequently debilitating problem for which few evidence-based interventions exist. A previous randomised trial found that participation in an online 6-week breathing and wellbeing programme (ENO Breathe), using singing techniques, was associated with improvements in health-related quality of life (HRQOL) and breathlessness. We aimed to assess the impact of this intervention outside a trial setting.
METHODS: In this cohort study, participants were referred from 51 UK-based National Health Service (NHS) long COVID clinics, where they had been diagnosed with breathlessness due to long COVID. The eligibility criteria of ENO Breathe were age 18 years or older, having long COVID with associated breathlessness, diagnosis and referral from a specialist collaborating NHS long COVID clinic, and access and ability to engage with the online programme. We compared baseline and post-intervention data to assess the effect of the ENO Breathe programme on HRQOL assessed using the RAND-36 Mental and Physical Health Composite (MHC and PHC) primary outcome, with an estimated minimally clinically important difference of 3; breathlessness (assessed using Dyspnoea-12 scores and visual analogue scales [VAS] for breathlessness at rest, walking, using stairs, and running); anxiety (assessed using the Generalised Anxiety Disorder-7 questionnaire [GAD-7]); and respiratory symptoms (assessed using the COPD Assessment Test [CAT]).
FINDINGS: 1413 programme participants were included in this analysis (mean age 49 years [SD 11·9], BMI 28 kg/m[7·2]). 1130 (80%) participants were female, 273 (19%) were male, and ten (1%) did not disclose their gender. 1165 (82%) participants were White, 87 (6%) were Asian, 47 (3%) were Black, 48 (3%) were of mixed or multiple ethnic backgrounds, 31 (2%) reported their ethnicity or race as other (ie, not one of the categories specified), and 35 (2%) did not disclose their ethnicity or race. Participants reported having long COVID symptoms for a median of 415 days (IQR 246-601) at the time of registration with the programme. 1188 (84%) of 1413 participants provided follow-up data on completion of the programme. Completing ENO Breathe was associated with improvements in HRQOL (median difference in RAND-36 MHC 2·98, IQR -1·53 to 8·42; and median difference in PHC 1·69, -1·32 to 5·01), breathlessness (mean difference in Dyspnoea-12 -4·29, 95% CI -4·64 to -3·94; VAS breathlessness scores walking median difference -5, IQR -18 to 6; stairs median difference -10, -25 to 3; and running median difference -3, -19 to 0), anxiety (median GAD-7 score difference -1, IQR -4 to 1), and respiratory symptom impact (mean CAT score difference -2·50, -2·81 to -2·19; all p<0·0001). The VAS breathlessness score at rest did not significantly change (median difference 0, IQR -10 to 13; p=0·24). The response to the ENO Breathe intervention did not differ by age, gender, ethnicity, or pre-existing asthma. There were no reported clinically significant adverse events. 2
INTERPRETATION: The ENO Breathe programme can improve HRQOL, breathlessness, anxiety, and respiratory symptoms in people with long COVID and breathlessness. ENO Breathe could be tested in other major causes of breathlessness and might help inform the development and delivery of other related interventions.
FUNDING: Imperial College London.
Long Covid