Community singing groups for people with chronic obstructive pulmonary disease: participant perspectives

Aim
Chronic obstructive pulmonary disease (COPD) is a major public health issue which is irreversible and progressive, but previous research suggests that singing may have beneficial effects. The aim of this study was to establish the views of participants with COPD taking part in a singing for better breathing programme.

Methods
This was a descriptive qualitative study nested within a single-cohort feasibility study which included measures of lung function and wellbeing. Participants (n=37) were interviewed following a community singing programme that ran over ten months in South East England.

Results
Findings support those from previous studies regarding the impact of singing on respiratory wellbeing. These included: the teaching on breath control, relaxation and the breathing exercises; singing as a means to deflect attention away from breathing problems, leading to increased activity levels; and the mutual support for respiratory problems. Beyond the impact on breathing, the singing was also seen as fun, and provided friendship and a ‘feel-good’ factor which led to motivation to participate in further activities. For some it was the highlight of the week, and singing together in a group was felt to be central to the benefits experienced. Findings are compared with the quantitative measures within the same study.

Conclusions
The majority of participants reported improvements in respiratory symptoms as well as mental and social wellbeing following the programme. The study contributes to the evidence base in supporting and highlighting the consistently positive experiences of a large sample of participants, despite variable outcomes in clinical measures.

1. Royal College of Physicians & Royal College of General Practitioners COPD in England – finding the measure of success (national COPD audit programme). London: RCP, 2016.

2. Department of Health. Consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England. London: Department of Health, 2010. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data...

3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket guide to COPD diagnosis, management and prevention. GOLD, 2017.

4. NICE. Chronic obstructive pulmonary disease in adults: quality statement (updated February 2016). London: National Institute for Health and Care Excellence, 2016.

5. British Thoracic Society. Guidelines on pulmonary rehabilitation in adults. Thorax 68, 1. London: BTS, 2013.

6. Clift S and Morrison I. Group singing fosters mental health and wellbeing: findings from the East Kent ‘singing for health’ network project. Mental Health and Social Inclusion 2011; 15, 2: 88-97.

7. Camic P M, Williams C M and Meeten F. Does a ‘singing together group’ improve the quality of life of people with a dementia and their carers? A pilot evaluation. Dementia 2011; 12,2: 157-176.

8.Bailey B A and Davidson J.W Effects of group singing and performance for marginalized and middle class singers. Psychology of Music 2005; 33,3: 269-303.

9.Bonilha AG, Onofre F, Vieira L M. et al. Effects of singing classes on pulmonary function and quality of life of COPD patients. International Journal of COPD 2008; 4,1: 1-8.

10. Lord VM, Cave P, Hume V. et al. Singing teaching as a therapy for chronic respiratory disease – randomised controlled trial and qualitative evaluation, BMC Pulmonary Medicine 2010; 10: 41. Available at: http://www.biomedcentral.com/1471-2466/10/41

11. Lord VM, Hume VJ, Kelly JL. et al. Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial, BMC Pulmonary Medicine 2012; 12: 69. Available at: http://www.biomedcentral.com/1471-2466/12/69

12. Goodridge D, Nicol J, Horvey K and Butcher S. Therapeutic singing as an adjunct for pulmonary rehabilitation participants with COPD: outcomes of a feasibility study. Music and Medicine 2013; 5, 3: 169-176.

13. Morrison I, Clift S, Page S. et al. A UK feasibility study on the value of singing for people with chronic obstructive pulmonary disease (COPD). UNESCO Observatory Multi-Disciplinary Journal in the Arts 2013: 3, 3:1-19.

14. British Lung Foundation (BLF). BLF singing project report. London: BLF, 2017.

15. McNaughton A, Weatherall M, Williams M. et al. Sing Your Lungs Out: a community singing group for chronic obstructive pulmonary disease: a 1-year pilot study. BMJ Open 2017; 7: 1-8. Doi:10.1136/bmjopen-2016-014151.

16. Engstrom CP, Persson L-O, Larrson S. et al. Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study. Thorax 1996; 51: 825-830.

17. Dodge R, Daly A P, Huyton J and Saunders L D. The challenges of defining wellbeing. International Journal of Wellbeing 2012; 2, 3:222-235.

18. Cooke P J, Melchert T P and Connor K. Measuring wellbeing: a review of instruments. The Counselling Psychologist 2016; 44, 5:730-757.

19. Skingley A, Page S, Clift S. et al. ‘Singing for Breathing’: participants’ perceptions of a group singing programme for people with COPD. Arts & Health 2014; 6, 1:59-74.

20. McNaughton A, Aldington S, Williams G. et al. Sing Your Lungs Out: a qualitative study of a community singing group for people with chronic obstructive pulmonary disease (COPD). BMJ Open 2016; 6: 1-7. Doi:10.1136/bmjopen-2016-012521.

21. Sandelowski M. Whatever happened to qualitative description? Research in Nursing & Health 2000; 23: 334-340.

22 . Clift S, Skingley A, Page S. et al. Singing for Better Breathing: findings from the Lambeth and Southwark singing and COPD project. Canterbury: Canterbury Christ Church University, 2017. Available from: http://www.canterbury.ac.uk/health-and-wellbeing/sidney-de-haan-rese...

23. Waring T and Wainwright D. Issues and challenges in the use of template analysis: two comparative case studies from the field. The Electronic Journal of Business Research Methods 2008; 6, 1:85-94.

24. Pawson R and Tilley N. Realistic Evaluation. 1997. London: Sage Publications Ltd.

25. Carlisle S and Hanlon P. ‘Well-being’ as a focus for public health? A critique and defence. Critical Public Health 2007; 18, 3:263-270.

26. Dunbar R I M, Kakatis K and MacDonald I. Performance of music elevates pain threshold and positive affect: implications for evolutionary function of music. Evolutionary Psychology 2012; 10, 4:688-702.

27. Fancourt D, Aufeggar L and Williamon A. Low-stress and high-stress singing have contrasting effects on glucocorticoid response. Frontiers in Psychology 2015; 6, 1242:1-5.

28. Craig P, Dieppe P, Macintyre S et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008:337:a1665. Doi:10.1136/bmj.o1665.

29. Alahmari A D, Mackay A J, Patel A R C et al. Influence of weather and atmospheric pollution on physical activity in patients with COPD. BMC Respiratory Research 2015; 16; 71. Doi: 10.1186/s12931-015-0229-z.