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Impact of laughter on air trapping in severe chronic obstructive lung disease

Authors Martin H Brutsche, Paul Grossman, Rebekka E Müller, Jan Wiegand, Pello, et al

Published 7 March 2008 Volume 2008:3(1) Pages 185—192


Martin H Brutsche1, Paul Grossman2, Rebekka E Müller1, Jan Wiegand1, Pello3, Florent Baty1, Willibald Ruch4

1Pneumology; 2Psycho-Somatic Medicine, University Hospital Basel, Petersgraben, Basel, Switzerland; 3Pello, Clown, Basel, Switzerland; 4Psychology, University of Zurich, Department of Psychology, Zurich, Switzerland

Abstract: Static and dynamic hyperinflation is an important factor of exertional dyspnea in patients with severe COPD. This proof-of-concept intervention trial sought to study whether laughter can reduce hyperinflation through repetitive expiratory efforts in patients with severe COPD. For small groups of patients with severe COPD (n = 19) and healthy controls (n = 10) Pello the clown performed a humor intervention triggering regular laughter. Plethysmography was done before and up to 24 hours after intervention. Laughing and smiling were quantified with video-analysis. Real-time breathing pattern was assessed with the LifeShirt™, and the psychological impact of the intervention was monitored with self-administered questionnaires. The intervention led to a reduction of TLC in COPD (p = 0.04), but not in controls (p = 0.9). TLC reduction was due to a decline of the residual volume. Four (22 [CI 95% 7 to 46] %) patients were ≥10% responders. The frequency of smiling and TLC at baseline were independent predictors of TLC response. The humor intervention improved cheerfulness, but not seriousness nor bad mood. In conclusion, smiling induced by a humor intervention was able to reduce hyperinflation in patients with severe COPD. A smiling-derived breathing technique might complement pursed-lips breathing in patients with symptomatic obstruction.

Keywords: bronchodilator, cheerfulness, COPD, dyspnoea, humor, hyperinflation

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