Music Therapy in Pediatric Asthma: A Short Review

Figures & data

Table 1 Classification of Asthma by Severity

	Types
	Mild	Moderate	Severe
Clinical manifestation	Infrequent exacerbations	Exacerbations more than twice a week	Daily wheezing
	Asymptomatic between exacerbations	Intermittent symptoms between exacerbations; Good exercise tolerance.	Symptoms between exacerbations
	Good exercise tolerance	Diminished exercise tolerance	Poor exercise tolerance
	Urgent or emergent care not necessary	Urgent or emergent care less than three times a year; decreased mid flows three times a year	Urgent or emergent care more than three times a year
	Generally normal peak flows, may have decreased mid flows	Peak flow and FEV1 60%–80%; Generally reversible with bronchodilators	Peak flow and FEV1 less than 60%; May not reverse with bronchodilator; may need steroids to demonstrate reversibility.
	Mild asthma is well controlled with low-intensity treatment, ie, as-needed low-dose ICS-formoterol, or low-dose ICS plus as-needed SABA.	Moderate asthma is currently defined as asthma that is well controlled with low- or medium-dose ICS-LABA in either treatment track.	Severe asthma is defined as asthma that remains uncontrolled despite optimized treatment with high-dose ICS-LABA, or that requires high-dose ICS-LABA to prevent it from becoming uncontrolled. Persistent problems with adherence or comorbidities such as chronic rhinosinusitis or obesity, as they need very different treatment compared with if asthma is relatively refractory to high-dose ICS-LABA or even OCS.

Abbreviations: FEV1, forced expiratory volume in 1s; SABA, short-acting beta 2 agonist; ICS-LABA, inhaled corticosteroid-long-acting beta2-agonist; OCS, oral corticosteroids.

Table 2 The Main Information of Appraised Studies

References	Number and Age of Subjects	Music Therapy Method	Detail Information in Therapy Method	Times	Effect Targets
					Relieves Symptom	Improves Medication Compliance	Improves Medication Use	Improves Lung Function	Improves Quality of Life	Regulates Mood
Wade^Citation2	9 (7–14 years old)	Listening to music Singing	Music assisted relaxation/15 min Vocal exercises and singing/15 min	4 weeks (twice a week)	×	×	×	√	√	√
Loewy^Citation6	173 (9–11 years old)	Listening to music Playing instruments Improvisation	Music-assisted relaxation Breathing exercises total: 30 min	6 months (once a week)	√	√	√	√	√	√
Eley^Citation11	27 (5–18 years old)	Listening to music Playing instruments Singing	Music-assisted relaxation Breathing exercises 1st: 60 min; 2nd: 90 min	6 months (once a week)	√	×	×	√	√	√
Andrew^Citation7	30 (5–16 years old)	Playing wind instruments	Playing the flute, clarinet, or cornet Breathing exercises and games total: 30 min	1 months (once a week)	√	×	√	√	×	×
Lucia^Citation12	18 (7–14 years old)	Playing wind instruments	Practice wind instruments/1 h	1 months (twice a week)	√	×	×	×	√	√
Lehrer^Citation8	10 (18 years old)	Listening to music	Music-assisted relaxation/1 h	4 months (every day)	√	×	×	√	×	×
Janiszewski^Citation13	96 (18–23 years old)	Music-assisted breathing exercises	Breathing exercises/1 h	1 years (every day)	×	×	×	√	×	√

Notes: √, MT has a positive effect on this aspect; ×, Research did not discussed or mentioned.

Table 3 Initial Asthma Medication Treatment

Object	Presenting Symptoms	Pharmacotherapy
Children aged 6–11 years	Infrequent asthma symptoms, eg, less than twice a month and no risk factors for exacerbations	Low-dose ICS taken whenever SABA is taken in combination or separate inhalers An alternative option is daily maintenance low-dose ICS with as-needed SABA
	Asthma symptoms or need for reliever twice a month or more, but less than daily	Low-dose ICS plus as-needed SABA. Other options include daily LTRA (less effective than ICS), or taking ICS whenever SABA is taken in combination or separate inhalers. Consider likely adherence with maintenance treatment if reliever is SABA.
	Troublesome asthma symptoms most days (eg, 4–5 days/week); or waking due to asthma once a week or more, especially if any risk factors exist	Low-dose ICS-LABA plus as needed SABA, OR Medium-dose ICS plus as-needed SABA, OR Very-low-dose ICS-formoterol maintenance and reliever. Other options include daily low-dose ICS and LTRA, plus as-needed SABA.
	Initial asthma presentation is with severely uncontrolled asthma, or with an acute exacerbation	Start regular maintenance treatment with medium-dose ICS-LABA plus as-needed SABA or low-dose ICS-formoterol maintenance and reliever (MART). A short course of OCS may also be needed.
Adolescents	Infrequent asthma symptoms, eg, less than twice a month and no risk factors for exacerbations, including no exacerbations in the last 12 months	As-needed low-dose ICS formoterol
	Asthma symptoms or need for reliever twice a month or more	As-needed low-dose ICS formoterol
	Troublesome asthma symptoms most days (eg, 4–5 days/week); or waking due to asthma once a week or more, especially if any risk factors exist	Low-dose ICS formoterol maintenance and reliever therapy
	Severely uncontrolled asthma, or with an acute exacerbation	Medium-dose ICS formoterol maintenance and reliever therapy (MART). A short course of oral corticosteroids may also be needed.

Abbreviations: ICS, inhaled corticosteroid; SABA, short-acting beta 2 agonist; LTRA, leuko triene receptor antagonist; ICS-LABA, inhaled corticosteroid-long-acting beta 2-agonist; OCS, oral corticosteroids.

Table 4 Pulmonary Function Index and the Effects of MT

Index	Definition	Abnormal Level	References/Effect of MT
			Wade^Citation2	Loewy^Citation6	Andrew^Citation7	Lehrer^Citation8	Eley^Citation11	Janiszewski^Citation13
FVC	Forced vital capacity	>normal value * 80%	×	FVC scores has no changed	×	FVC scores increase (from 88.6% to 93.7%)	FVC scores increase, but changes in detail was not discussed.	FVC scores increase, but changes in detail was not discussed.
FEV1	Forced expiratory volume in 1s		×	FEV1 scores increase (from 81% to 85%)	×	FEV1 scores increase (from 73.5% to 79.1%)	FEV1 scores increase but changes in detail was not discussed	FEV1 scores increase, but changes in detail was not discussed
FEV1% (FEV1/FVC)	Forced expiratory ratio in 1s		×	FEV1% scores increase (from 89% to 97%)	×	FEV1% scores increase (from 66.7% to 68.5%)	×	×
PEF	Peak expiratory flow		PEF scores increased after singing, but changes in detail was not discussed.	PEF scores increase (from 61% to 66%).	PEF scores increase (from 77% to 96%).	×	×	×
MEF25	Maximal expiratory flow with 25% expiration		×	×	×	×	×	×
MEF50	Maximal expiratory flow with 50% expiration		×	×	×	×	×	×
MEF75	Maximal expiratory flow with 75% expiration		×	×	×	×	×	×

Notes: *Normal values obtained from patient data, including height, weight, age, gender; ×, Research did not discussed or mentioned.

Figure 1 Clinical referral procedures and future research directions of MT.

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