Music May Make Airway Clearance Sessions More Enjoyable for Children

Music composed especially for children with cystic fibrosis (CF) made airway clearance therapy a more enjoyable task, suggesting that it can help with treatment adherence and potentially lower costs related to pulmonary exacerbations, a study suggests.

The study, “Effects of music therapy as an adjunct to chest physiotherapy in children with cystic fibrosis: A randomized controlled trial,” was published in PLOS One.

Daily airway clearance therapy (ACT) helps to clear the mucus that builds up due to CF in patients’ lungs but demands significant time and energy, leading to low overall adherence rates, which minimizes the treatment’s benefit.

Making an ACT routine more enjoyable might improve adherence, helping patients to benefit more from the procedure and potentially lowering the costs of care related to complications such as pulmonary flares.

Although music therapy is already used as an adjunctive, or complementary, treatment in pulmonary diseases to ameliorate physical or psychological and emotional burden, few studies have examined its usefulness or sought to establish best practices.

One study that did found that toddlers with CF responded better to music specifically composed for ACT sessions than to familiar music. Its potential with older children, however, had not been investigated.

To address this, researchers with Universidad de Málaga, in Spain, recruited 43 children with CF between the ages of 2 and 17 to participate in a randomized controlled trial (ISRCTN11161411). The goal “was to evaluate the effects of specifically composed and recorded instrumental music as an adjunct to ACT,” the researchers wrote.

Patients were divided into three groups. A placebo group of 13 patients listened to familiar music during ACT sessions, and a control group of 15 others followed the standard practice of the ACT routine with no music.

A treatment group of 15 patients listened to music composed specifically to make ACT sessions more enjoyable. A professional musician and a music teacher played and recorded the music under the guidance of hospital CF specialists.

The music aimed to meet four goals: to encourage enjoyment; to encourage deep breaths during the inhaled treatment portions, by relaxing children while holding their interest; to improve mucus clearance through rhythmic support for airway clearance techniques; and, to distract children from the time spent on the routine.

Over three months, participants rated how much they enjoyed their ACT sessions on a seven-point scale (–3 to +3) and guessed at how long they thought each session lasted — the trial’s two primary outcomes. Children’s parents also rated their enjoyment of the sessions.

As a secondary goal, the trial also assessed the efficacy of music therapy by estimating the cost of healthcare resources avoided by not having to treat exacerbations requiring hospitalization due to a respiratory infection.

Children using the composed music reported the greatest increases in enjoyment over the trial. This change was significant, although the differences between each group were not. On average, the change — measured in units on the seven-point scale — was +0.9 for the treatment group, +0.56 for the placebo group, and –0.06 for the control group.

Parents largely mirrored this result, showing changes of +1.7 units in the treatment group, +0.5 in the placebo group, and +0.14 in the control group.

Use of the composed music seemed to also make the time pass faster. Children in the treatment group felt, on average, that their sessions lasted 11.1 minutes shorter than they actually did. Placebo-group  patients group reported perceiving their sessions as nearly four minutes longer than the actual time, while those in the control group, with no music, reported feeling their sessions took nine minutes longer.

These changes in perception of time from the study’s start, and the differences among the three groups were considered statistically significant.

All but one treatment-group patient called the new recorded music useful; the other 14 said that they would consider using it in future. In the placebo group, seven children called their familiar music useful and five would consider using it for their ACT sessions.

One child in the treatment group had a pulmonary exacerbation during the study, as did three in the placebo group and six among the control group. In the three months before the study, two exacerbations were reported in the treatment group, and one in each of the other two groups.

Official Spanish healthcare data estimated the cost of a hospitalization for CF at about €6,704.87 ($8,030), making that value the therapy’s potential cost saving per visit.

Overall, the study indicated that specially composed music will complement ACT by making sessions more enjoyable and reducing costs.

With this music therapy intervention “we can expect better clinical outcomes in CF patients without changes in treatment regimens or programmed clinic visits in CF units,” the team concluded.

Nonetheless, “further long-term studies are needed to analyze whether this positive experience of ACT has any sustained effects, patients’ perspectives, as well as the efficiency of the intervention in terms of lung function,” the researchers added.