The Singer's Breath: Implications for Treatment of Persons with Emphysema

By Engen, Rebecca L. | Journal of Music Therapy, Spring 2005 | Go to article overview
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The Singer's Breath: Implications for Treatment of Persons with Emphysema

Engen, Rebecca L., Journal of Music Therapy

This study investigated the effects of group singing instruction on the physical health and general wellness of senior citizens with emphysema. Subjects (n = 7) participated in 6 weeks of group vocal instruction, which emphasized breath management techniques. Dependent measures reflected physical health, functional outcomes, and quality of life. No significant differences were found on measures of physical health (FEV^sub 1^, inspiratory threshold, distance walked, and The DUKE physical health subscale). Measures of functional outcomes each showed a significant change across time. Results of the ANOVAs for breath management (extent of counting) and breath support (intensity of speech) were significant (p < .038 & p < .000 respectively). Descriptive analyses showed a clear and dramatic shift in breathing mode from clavicular to diaphragmatic breathing that was maintained 2 weeks after the treatment period. Quality of life measures (subjective scales and The Duke Health Profile,) yielded mixed results. Findings of this study suggest that vocal instruction, inclusive of breathing exercises, may help to improve the quality of life for senior citizens with emphysema. Subjects in this study responded positively to the instruction and further investigation of the treatment method is warranted.

The occurrence of chronic obstructive pulmonary disease (COPD) is on the rise in the United States. This degenerative disease, currently affecting over 13.5 million Americans, is the fourth leading cause of death in America (Swyberius, 2001; U.S. Department of Health and Human Services Centers for Disease Control and Prevention, 1999). As recently as 1993, the National Institutes of Health (NIH, 1993) listed COPD as the fifth leading cause of death in the United States. The economic impact of this disease is enormous when considering lost workdays and decreased productivity, visits to the doctor, hospitalization, prescriptions, oxygen, and home health assistance (Ahlheit, 1995; Craig, 1988; Higgins, 1984; NIH, 1993). Economic issues are not the only concern; emotional costs are also considerable. Persons with emphysema (a type of COPD) typically experience social withdrawal, anxiety, and fear related to breathing difficulties, and perhaps most significantly, loss of control and feelings of helplessness (Connelly, 2001). Powers (1997) states,

The experience of chronic illness is unique to the individual and not limited to the pathophysiology of the disease. While disease may be the problem from the health care provider's perspective, the issue for older adults with various incurable conditions is how to live with and respond to symptoms and disabilities, (p. 136)


Emphysema is one of two types of chronic obstructive pulmonary disease (COPD). Chronic bronchitis is the other form. While emphysema certainly presents a serious medical problem, the nature of the disability is often primarily functional rather than medical. By nature, emphysema poses daily limits on activity and is a chronic problem; chronic bronchitis more often results in acute attacks. Because of these differences in symptom presentation, this study limited itself to persons with a physician's diagnosis of emphysema or COPD, probable emphysema.

In most cases, smoking is the most important risk factor for developing COPD. Since only 15% to 20% of smokers develop the disease, other risk factors such as age, repeated environmental exposure to smoke or pollution, frequent respiratory infections in childhood, low socioeconomic living conditions, and other yet unknown factors also contribute to its development (Hercules, Lckwart, & Fcnton, 1979; Higgins, 1984; Hong & Ingram, 1998; NIH, 1993). There is also a rare form of emphysema caused by an inherited deficiency of a blood component, alpha-1-antitrypsin. It is estimated that 1% to 3% of all emphysema cases are due to this deficiency (NIH, 1993).

COPD is a degenerative disease that worsens over time.

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The Singer's Breath: Implications for Treatment of Persons with Emphysema


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