Combine Effect of singing and pulmonary rehabilitation on COPD

Introduction

Though it is an ancient disease Chronic obstructive pulmonary(COPD) disease is not uncommon even today. The prevalence and incidence is significantly high. The Global Initiative for COPD has classified in 4 groups, based on lung function and disease symptoms.The commonly seen symptoms in patient with COPD are dyspnea, sputum , fatigues, altered lung function and exercises tolerance, and some others. This symptoms are directly associated with disease burden and quality of life. (1-3)

Role of Pulmonary Rehabilitation in COPD

There are many proven therapies available for management of COPD and pulmonary rehabilitation is one of them. Pulmonary rehabilitation comprises of aerobic exercises, resisted exercises, breathing exercises, and some others components. As pulmonary rehabilitation is not just exercises but also education and behavior management, it has significant impact on muscle strength, endurance, exercises tolerance, lung function and also on Quality of life. (4,5) Additionally research has proved that some recreational activity improves quality of life and helps the individual to live with disease as they fun activities for individual and doesn’t have much relevance with expertise in performing makes them more enjoyable. (6)

Effect of Singing on Lung Function and COPD

Singing is one of the common hobbies for many individuals. People like to sing casually many a times along with other activities such as bathing, driving etc. Music is also known as an enjoyable activity and a mood elevator for many. It has to be accepted that for gaining therapeutic benefits from signing , activity has to be done in systemic manner on a regular basis. Usually one singing class includes pre-singing session in form of respiratory muscle relaxation, vocalization exercises by loud and rhythmic pronunciation of vowels, demonstration of song and explanation of singing technique by an expert. Though singing expertise should not expected from participants with COPD but still training is necessary for better outcome. It is suggested that singing sessions can be planned in a group before or after the pulmonary rehabilitation sessions. (7,8,9)

How singing helps?

Based on research it is known that singing can have some effect on quality of life and also on lung function. Singing is believed to improve symptoms in COPD and quality of life as it requires specific amount of voice production. Controlled Respiration is essential for voice production. (10, 11,12) It is understandable that singing can not be solely given to patient of COPD as a replacement of pulmonary rehabilitation. But singing can be helpful as singing incorporates controlled active expiration. Controlled active expiration can be helpful in improving respiratory muscle function particularly diaphragm an also on elastic recoil in some extent. Active expiration increases pressure over elastic recoil and diaphragm, so inspiration following active expiration is facilitated (10,12). Hyperinflation in COPD is one of the common symptoms which can be improved with better functioning of elastic recoil. Controlled expiration can help patient understand his own pattern and amount of dyspnea which can further help patient to understand severity of disease. Many a time patient thinks after having COPD they are supposed to limit their activities because of dyspnea and should not participate in leisure activities. That can again lead to alter the patients’ perception for dyspnea. Group singing facilitates mood and social interaction among patients. singing session can increase motivation and adherence to therapy sessions. So There must be a combine mechanism for improvement in dyspnea and quality of life with singing classes.(5,7,13)

         Thus, Singing can be considered as a tool to improve lung function and Quality of life in patient with COPD.