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Data sharing: Fully anonymised data will be provided upon reasonable request to the corresponding author. Copyright © 2022 The Author(s). Background: There are few evidence-based interventions for long COVID; however, holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. Methods: We conducted a parallel-group, single-blind, randomised controlled trial in patients who had been referred from one of 51 UK-based collaborating long COVID clinics. Eligible participants were aged 18 years or older; were recovering from COVID-19 with ongoing breathlessness, with or without anxiety, at least 4 weeks after symptom onset; had internet access with an appropriate device; and were deemed clinically suitable for participation by one of the collaborating COVID-19 clinics. Following clinical assessment, potential participants were given a unique online portal code. Participants were randomly assigned (1:1) to either immediate participation in the English National Opera (ENO) Breathe programme or to usual care. Randomisation was done by the research team using computer-generated block randomisation lists, with block size 10. The researcher responsible for randomisation was masked to responses. Participants in the ENO Breathe group participated in a 6-week online breathing and wellbeing programme, developed for people with long COVID experiencing breathlessness, focusing on breathing retraining using singing techniques. Those in the deferred group received usual care until they exited the trial. The primary outcome, assessed in the intention-to-treat population, was change in HRQoL, assessed using the RAND 36-item short form survey instrument mental health composite (MHC) and physical health composite (PHC) scores. Secondary outcome measures were the chronic obstructive pulmonary disease assessment test score, visual analogue scales (VAS) for breathlessness, and scores on the dyspnoea-12, the generalised anxiety disorder 7-item scale, and the short form-6D. A thematic analysis exploring participant experience was also conducted using qualitative data from focus groups, survey responses, and email correspondence. This trial is registered with ClinicalTrials.gov, NCT04830033. Findings: Between April 22 and May 25, 2021, 158 participants were recruited and randomly assigned. Of these, eight (5%) individuals were excluded and 150 participants were allocated to a treatment group (74 in the ENO Breathe group and 76 in the usual care group). Compared with usual care, ENO Breathe was associated with an improvement in MHC score (regression coefficient 2·42 [95% CI 0·03 to 4·80]; p=0·047), but not PHC score (0·60 [–1·33 to 2·52]; p=0·54). VAS for breathlessness (running) favoured ENO Breathe participation (−10·48 [–17·23 to –3·73]; p=0·0026). No other statistically significant between-group differences in secondary outcomes were observed. One minor self-limiting adverse event was reported by a participant in the ENO Breathe group who felt dizzy using a computer for extended periods. Thematic analysis of ENO Breathe participant experience identified three key themes: (1) improvements in symptoms; (2) feeling that the programme was complementary to standard care; and (3) the particular suitability of singing and music to address their needs. Interpretation: Our findings suggest that an online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind–body and music-based approaches, including practical, enjoyable, symptom-management techniques might have a role supporting recovery. Imperial College London

ObjectivesThis study aimed to investigate the presence of perceived stressors, psychological safety and teamwork in healthcare professionals. As the timeframe for this study spanned the first wave of the COVID-19 pandemic, data were captured demonstrating the impact of the pandemic on these factors.DesignQualitative interview study.SettingAll staff working within the emergency and critical care departments of one National Health Service Trust in London, UK.ParticipantsForty-nine participants were recruited using a purposive sampling technique and interviewed when the first wave of the COVID-19 pandemic had subsided.Main outcome measuresEvaluation of changes in perceived stressors, psychological safety and teamwork in individuals working during the COVID-19 pandemic.ResultsThe thematic analysis relating to a participant’s lived experiences while working during COVID-19 led to the construction of five key themes, including ‘psychological effects’ and ‘changes in team dynamics’. Several psychological effects were described, including the presence of psychological distress and insights into the aetiology of moral injury. There was marked heterogeneity in participants’ response to COVID-19, particularly with respect to changes in team dynamics and the perception of a psychologically safe environment. Descriptions of improved team cohesiveness and camaraderie contrasted with stories of new barriers, notably due to the high workload and the impact of personal protective equipment. Building on these themes, a map of key changes arising due to the pandemic was developed, highlighting potential opportunities to provide targeted support.ConclusionsWorking on the front line of a pandemic can have significant implications for healthcare workers, putting them at risk of psychological distress and moral injury, as well as affecting team dynamics. There is striking heterogeneity in the manifestation of these challenges. Team leaders can use the themes and qualitative data from this study to help identify areas for management focus and individual and team support.

Introduction Bronchiectasis patients rely on self-management to minimise symptoms, prevent exacerbations, and halt disease progression. A collaboration between Imperial College London, the Trust, and three patient partners was developed to transform the current paper-based self-management plan into a digitised tool embedded in the personal health record. The aims of this project are to improve the appropriateness of healthcare utilisation, provide easy access to care information, share information across the care team, and digitise routine patient education (e.g. airway clearance). Methods We convened a series of codesign workshops with representatives of the bronchiectasis multidisciplinary team and three public partners who live with bronchiectasis. Participants developed an idealised self-management webpage, in terms of contents, practical use, and potential patient safety risks. The contents of the plan were also informed by an expert panel with national representation. A priority-setting exercise with the entire multidisciplinary team identified highest-priority features. The prototype was then adapted for inclusion in the patient-facing record. A process evaluation will guide revisions to the plan. Correlations between engagement, health status, and demographic variables will also be explored. Results The expert panel produced a list of 20 key skills and information for effective self-management. There was a high degree of consensus on what should be included, with 97.2% of participants agreeing on the final set. Topics included: airway clearance, shared decision-making, antimicrobial resistance, and knowing when to seek medical help. Figure 1 summarises the key features of the digital self-management plan, as identified by the codesign group. Highest priority features were 1) the exacerbation action plan, 2) videos demonstrating proper airway-clearance techniques, and 3) goal-setting. These three priorities were taken forward for the initial launch. Discussion Previous implementation research suggests that digital interventions fail when they neglect to account for user experience (van Gemert-Pijnen et al. 2011, DOI: 10.2196/jmir.1672). This project produced a digital self-management plan in collaboration with both patient partners and the multidisciplinary team who will use the plan. We plan to quantify the impact of this tool through patient and clinician feedback, as well as engagement data.

IntroductionSinging for lung health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however, research on impact is limited. The ‘SLH: Improving Experiences of Lung Disease trial’, a randomised controlled, single (assessor) blind, trial of 12 weeks SLH versus usual care for people with chronic obstructive pulmonary disease (COPD) (n=120) was setup to help to address this. The first group (n=18, nine singing and nine controls) started face-to-face (five sessions) before changing to online delivery (seven sessions) due to COVID-19-related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area.MethodsWe conducted semistructured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, premeasures and postmeasures of quality of life and disease impact (Short Form 36 Health Survey, COPD Assessment Test score), breathlessness (Medical Research Council breathlessness scale, Dyspnoea-12), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalised Anxiety Disorder-7), balance confidence (Activity specific Balance Confidence, ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy).ResultsAttendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semistructured interviews identified three themes regarding participation in SLH delivered face to face and online, these where (1) perceived benefits; (2) digital barriers (online) and (3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect −4.78 PHQ-9 points, pDiscussionThis study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and improved balance confidence.

IntroductionSinging for Lung Health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions, which participants report provides biopsychosocial benefits, however research on impact is limited. The ‘SHIELD trial’, a randomised controlled, single (assessor) blind, trial of 12 weeks SLH vs usual care for people with Chronic Obstructive Pulmonary Disease (COPD) (n=120) was set-up to help to address this. The first group started face-to-face (5 sessions) before changing to online delivery (7 sessions) due to COVID-19 related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area.MethodsWe conducted semi-structured interviews and thematic analysis regarding barriers, facilitators and key considerations regarding transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, pre and post measures of quality of life and disease impact (SF-36, CAT score), breathlessness (MRC breathlessness scale, Dyspnoea-12), depression (PHQ9), anxiety (GAD-7), balance confidence (ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy).ResultsAttendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semi-structured interviews identified three themes regarding participation in SLH delivered face-to-face and online, these where 1) perceived benefits; 2) digital barriers (online); 3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect −4.78, p= 0.0487, MCID 5) balance confidence (treatment effect +17.21, p=0.0383, MCID 14.2), and anxiety (treatment effect −2.22, p=0.0659, MCID 2).DiscussionThis study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and anxiety, and improved balance confidence.KEY MESSAGESWhat is the key question?Can Singing for Lung Health (SLH) be delivered online for people with COPD? And if so, what are the practical issues and how does the experience compare with face-to-face participation?What is the bottom line?SLH appears safe and enjoyable both face-to-face and online. Access barriers for online sessions included digital access and literacy. However increasing access to those previous unable to physically access sessions is also important. In this pilot, depression, anxiety and balance confidence appear to show improvements related to participation in a SLH group that transitioned from face-to-face to online delivery.Why read on?To our knowledge this is the first study to assess health impacts of online group singing sessions. Given the physical distancing measures required by the response to COVID-19, there is a need for singing groups and other similar interventions to be delivered online such as pulmonary rehabilitation. This study helps to inform this and future research in the area.

Background Pulmonary rehabilitation (PR) is recognized as a core component of the management of patients with COPD.1 Although the benefits of PR in COPD are well established, there remain a number of unanswered questions regarding how to maximise performance during PR, including the use of ambulatory oxygen. Studies investigating the effects of oxygen use during PR have had conflicting results.2 Therefore, we aimed to investigate the effect of ambulatory oxygen on PR outcomes in COPD patients Methods Patients with COPD referred to PR and have exercise desaturation (spo2 Results 20 patients (female-8) were recruited between April 2016- 2017, one patient withdrew after consent. There was no significant difference in the 6MWD and CRQ between the oxygen (n=9) and no oxygen group (n=10). In the oxygen group 56%, declined oxygen and 11% had no oxygen desaturation following PR. In the non-oxygen group, 40% declined oxygen and 20% had no exercise desaturation following PR. Conclusion Use of ambulatory oxygen during PR, did not improve the 6MWD following completion of PR in COPD patients. Higher proportion of people in the oxygen group declined oxygen after completion of PR; this was mainly due to no perceived benefit with improving functional activity reported by patients. Also 16% of patients did not desaturate after completion of PR. This raises the question it may be better to assess patients for ambulatory oxygen following completion of PR. References Pulmonary rehabilitation for COPD. McCarthy B, et al. Cochrane Reviews 2015 Ambulatory Oxygen for Exercise-Induced Desaturation and Dyspnea in COPD : Systematic Review and Meta-Analysis Ejiofor, et al. Journal of the COPD Foundation 2016.