ENO breathe: An arts and health alliance to help COVID-19 recovery

Introduction: Breathlessness, anxiety and fatigue can persist months after acute COVID-19 illness and options to aid recovery are limited. Data show singing programmes may improve health status in chronic lung disease. Aim: To assess the impact of a singing programme for patients recovering from COVID-19. Methods: ENO breathe is a 6 week online small-group programme developed by the English National Opera in partnership with an NHS trust. It teaches breathing techniques and lullabies to COVID-19 patients. A pilot was run for people with persistent dyspnoea at outpatient follow up 8-12 weeks after hospital discharge. Participants completed pre and post-programme questionnaires including; dyspnoea (0-10 visual analogue scale), anxiety (GAD7) and wellbeing (RAND37). Participants’ views of the programme were gained in mid and post-programme focus groups. Two researchers independently analysed the data and identified themes. Results: 12 participants aged 32–77 completed the programme. 82% reported improved dyspnoea and 90% reduced anxiety. There was a significant improvement in GAD7 (median 4.5 vs 3.4 p=0.007) and dyspnoea at rest (5 vs 2.5 p=0.045) and a trend towards improvement in exertional dyspnoea and RAND37. Participants described singing lullabies enjoyable, calming and a useful distraction from their breathing. The breathing techniques learnt, helped participants cope better with daily symptoms. Group sessions combatted loneliness and participants valued meeting others with a shared COVID-19 experience. Conclusion: An arts in health approach based around singing, can help with dyspnoea and anxiety in patients recovering from COVID-19. This social prescribed intervention has now rolled out across 25 UK trusts.