ENO Breathe study finds improvements for long COVID patients
Research carried out by Imperial College London analysed outcomes from 1,438 participants referred through 51 National Health Service long COVID services across England.
English National Opera’s ENO Breathe programme has been shown to deliver clinically meaningful benefits for people experiencing long COVID symptoms, according to a new study published in The Lancet Digital Health.
The study found significant improvements in quality of life, breathlessness, anxiety and respiratory symptoms, with no serious adverse events reported.
ENO Breathe is a free, live six-week online programme developed by English National Opera in collaboration with clinicians from Imperial College Healthcare NHS Trust. It uses breathing retraining, singing techniques and wellbeing support, with a particular focus on lullabies from around the world.
The programme is delivered through live online group sessions led by specially trained ENO vocal specialists and facilitators, supported by digital resources that participants can use in their own time. It is designed to complement clinical care and is accessed through referral from partnered NHS services.
Since launching in September 2020, ENO Breathe has taken referrals from 85 NHS partners nationally and supported more than 4,829 participants to complete the programme. ENO says its ongoing evaluation has found that 80% of participants reported improved breathlessness, 73% reported improved anxiety and 87% said the programme had a positive impact on their general wellbeing.
The newly published study found that 61% of participants achieved clinically important improvements in breathlessness. The findings build on earlier evidence from a randomised controlled trial published in The Lancet Respiratory Medicine in 2022.
Lead author Dr Keir Philip, Clinical Lecturer at the National Heart and Lung Institute at Imperial College London and Honorary Consultant in Respiratory and General Medicine at Imperial College Healthcare NHS Trust, said the study showed ENO Breathe could improve symptoms ‘in the real world, not just in a clinical trial’.
He added, ‘The participants experienced important improvements in respiratory symptoms, mental health and quality of life, all while doing something they really enjoyed. Central to this programme is that it treats people as people, not just numbers, and capitalises on their pleasure in joining in with others.’
Dr Sarah Elkin, medical lead for ENO Breathe and Honorary Clinical Senior Lecturer at Imperial College, said the findings provided ‘robust evidence’ that the programme could support both physical and psychological outcomes for people living with long COVID.
Beth Warnock, Director of Engage, ENO’s learning and participation department, said the research demonstrated ‘the powerful role the arts can play within healthcare, particularly when delivered in close partnership with clinicians’.
Through 2026–27, ENO will pilot an expanded version of ENO Breathe in London and Greater Manchester for people living with chronic respiratory conditions, including COPD and asthma. During the pilot, referrals will be accepted only through partnered NHS services in those regions.
ENO Breathe will also continue to accept referrals for people experiencing ongoing breathlessness after Covid-19, as well as those with similar post-viral symptoms.