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The comparison between pulmonary rehabilitation with music therapy and pulmonary rehabilitation alone on respiratory drive, cortisol level and asthma control in patients hospitalized with asthma exacerbation

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Institution
Jagiellonian University Medical College, Kraków, Poland
Institution Typology
University
Country
Poland
Description
Intervention design
The study was an interventional double-blinded randomized controlled trial. Hospitalized patients with asthma exacerbation enrolled in the study were randomly assigned to experimental (music therapy) or control (popular science program) group. Both groups during hospitalization received standard pharmacotherapy accompanied by respiratory physiotherapy.

People involved
Hospitalized adult patients with asthma exacerbation
G1: the experimental group n= 39
G2: control group n=34
Age: G1: M=64.00 years, G2: M= 58.00 years

G1: received standard pharmacotherapy in conjunction with respiratory physiotherapy and receptive music therapy. During the music therapy, the subjects received headphones to listen to recordings of relaxing music from mp3 files prepared by music therapists.
The physiotherapy sessions were adjusted to the patients’ condition and could include: airway clearance techniques, reeducation of the breathing pattern, diaphragmatic breathing and techniques to reduce shortness of breath. Depending on each patient’s subjective feeling, the vibration therapy was performed using a special vest in a sitting position or the Medex 3D device in a modified drainage position while lying on the sides. The patients’ position depended on the location of their auscultatory changes.
The patients assessed a selection of 24 recordings of relaxing music, previously prepared by a music therapist. A compilation was created by selecting 10 recordings with the highest rating. It was played to the patients after the rehabilitation was completed every day throughout their hospitalisation. The music therapy took part in the patients’ rooms, with the subjects lying on their beds and listening to the music from their own devices (mp3 players). The co-users and medical staff were asked to remain silent during the session.
Musical compositions used in music therapy i.e:
- Country Waltz (Banda Sonora; BS The Straight Story)
- Comptine d'Un Autre Été (Yann Tiersen; Amelie)
- Farewell for piano (Zbigniew Preisner; Preisner, 10 Easy Pieces for Piano)
- No 3 Andante moderato (Jean Doyen; Pavane The Music of Gabriel Faure)
G2: control group received standard pharmacotherapy in conjunction with respiratory physiotherapy. Instead of a music therapy, they were
asked to listen to radio broadcasts about popular science
and nature.

Identified barriers: contraindications to pulmonary rehabilitation, such as acute phase of coronary heart disease or pulmonary hypertension, significant hepatic dysfunction, severe cognitive impairment or advanced cancer-induced damage to the auditory system, impairment of oral sphincters whose pressure is needed to keep the mouthpiece of the measuring apparatus safely in place.
Transferability:
Adult patients with asthma
Disease
Asthma
Activity level
Medium
Activity Typology
Rehabilitation section-based activities
Motivation Tools
Not available

Innovation
The applied set of relaxation recordings, based on the previously examined musical preferences of this group of patients, proved to be an effective form of therapeutic influence. Passive music therapy, affecting the mental state of patients, seems to improve the efficiency of the respiratory system.


Evaluation System
Evaluation tools: asthma control (using the Asthma Control Test), respiratory drive, blood cortisol level, dyspnea level (the Borg scale) and the quality of life ( Asthma Quality of Life Questionnaire).

During the hospitalization, the levels of the inspiratory occlusion pressure for the first 0.1 s of inspiration decreased and the maximum P0.1 increased only in the experimental group. The serum cortisol level decreased in both groups. The changes in asthma control and quality of life did not reach significant levels in either subject group


Assessment
The simplicity of its implementation and the low costs make this type of therapy highly accessible, in view of the previously identified demand for relaxation methods in this group of patients.

References
Śliwka A, Kaszuba M, Piliński R, et al. The comparison between pulmonary rehabilitation with music therapy and pulmonary rehabilitation alone on respiratory drive, cortisol level and asthma control in patients hospitalized with asthma exacerbation. J Asthma. 2021;58(10):1367-1376. doi:10.1080/02770903.2020.1789874

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