Mild Humor & Laughter Support Breathing in COPD Patients

[This article was adapted from McGhee, P.  Humor: The  Lighter Path to Resilience and Health.  Bloomington, IN: AuthorHouse.  References to the research discussed below are presented in this book.]

Intuitively, you would assume that laughter would not be a good idea for patients with chronic obstructive pulmonary disease, or COPD—a condition (which may result from emphysema or chronic bronchitis) characterized by generally irreversible airway obstruction (air trapping), resulting in a slowed rate of exhalation.  In COPD, the bronchial passages are seriously impaired in their ability to rid the lungs of air, leading to hyperinflation.  “Pursed lip” breathing is often recommended to help patients get a good exchange of air in the lungs.  Bronchodilators are also used to help empty air and reduce the level of hyperinflation.

On the one hand, you might expect the forcefulness of hearty laughter to help force more air through the bronchi and reduce the level of trapped air.  We know that laughter does reduce residual air in the lungs of healthy individuals.  But if the laughter does not successfully push out trapped air in COPD patients, it could actually cause more air to get trapped in the lungs.  When a healthy person laughs hard, a series of expiratory pushes (the “ha ha’s”) rapidly forces air out until we run out of air.  We then take a quick deep breath and continue pushing air out until the hilarity settles down.  For a COPD patient, if the lungs do not permit this rapid expulsion of air, the deep inspirations could actually increase the level of trapped air.  This is why slow and steady breathing is generally seen as the way to go for these patients.

One very recent study has taken the first step toward determining the possible value or harm of laughter for COPD patients.  Lung volume was measured in patients with severe COPD and healthy controls both before and after a performance by a clown within the hospital.  (COPD patients have greater lung volume in their residual air, as well as immediately after a full inspiration—defined as “total lung capacity” or TLC—in comparison to healthy individuals).  This was a very funny clown who worked well with adults, and a lot of laughter occurred among both patients and the control adults.  Total lung capacity was significantly reduced among the COPD patients, but not in the control group.  (This reduction in TLC was relatively short-lived, however; it was no longer present two hours later.)  Among those patients showing the greatest reduction of TLC (10% or more), there was a sharp drop in residual air volume.  This suggests that a reduction in air-trapping did occur for them. 

Since one concern prior to this study was whether laughter would even be safe for COPD patients, it should be noted that the researchers concluded that mild laughter is safe for this patient group—even for patients with severe COPD.  But they also found that patients showing the most intense laughter did show increased hyperinflation.  It was “gentle” laughter that was associated with reduced lung volume.  This suggests that COPD patients should be cautioned to restrict their laughter to more moderate levels

Of special interest is the finding that those patients who showed the greatest reduction in trapped residual air smiled more than patients showing minimal reduction in trapped residual air.  So smiling may also help COPD patients get rid of trapped air and breathe more easily.  These researchers specifically recommended that smiling-while-breathing be considered as an additional breathing technique, along with the traditional pursed-lip breathing.  To be most effective, this should be encouraged in the context of comedy videos, friendly banter, or any other approach to generating amusement in patients.

This article may not be copied or reproduced without the permission of Paul McGhee.