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New study shows that ENO Breathe, an online breathing and wellbeing programme, significantly improves quality of life for people living with long COVID.

Published in ,  the study led by researchers at Imperial's National Heart and Lung Institute (NHLI), found that ENO Breathe, developed by English National Opera (ENO), in collaboration with clinicians from Imperial College Healthcare NHS Trust (ICHT), delivers significant improvements for people living with long COVID. The research demonstrates measurable benefits in quality of life, breathlessness, anxiety and respiratory symptoms, providing robust clinical evidence for the programmes' impact on long-term respiratory and mental wellbeing. 

Long COVID is still a really important health issue, negatively impacting quality of life and limiting what people can do, and this study shows that ENO Breathe can improve a range of symptoms in the real world Dr Keir Philip Clinical Lecturer, Imperial's National Heart and Lung Institute

ENO Breathe is a free, live six‑week online breathing and wellbeing programme available nationally through referrals from partnered NHS Trusts. Using singing techniques with a particular focus on lullabies from around the world, the programme aims to improve breathing, wellbeing and quality of life for people living with long COVID and related breathlessness. 

The programme combines breathing retraining, singing techniques and wellbeing support, delivered through live online group sessions led by specially trained ENO vocal specialists and facilitators, alongside flexible digital resources that participants can access in their own time. Designed to complement clinical care, ENO Breathe accepts participants following assessment and referral through specialist healthcare pathways, ensuring it integrates safely and effectively alongside NHS specialist services supporting patients with post-COVID symptoms. 

The newly published study analysed outcomes from 1,438 participants referred through 51 NHS long COVID services across England, making it one of the largest real‑world evaluations of a creative health intervention for long COVID breathlessness to date. Participants who completed the six‑week programme experienced clinically meaningful improvements across multiple validated health measures, with 61% achieving clinically important improvements in breathlessness. Engagement levels were high, and no serious adverse events were reported. 

These findings build on earlier evidence from a Randomised Controlled Trial published in The Lancet Respiratory Medicine in April 2022, further strengthening the clinical evidence base for ENO Breathe and its potential for integration at scale within NHS services.

Lead author of the study,, Clinical Lecturer at Imperial's NHLI and an Honorary Consultant in Respiratory and General Medicine at ICHT said: “Long COVID is still a really important health issue, negatively impacting quality of life and limiting what people can do, and this study shows that ENO Breathe can improve a range of symptoms in the real world, not just in a clinical trial. 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.”

Since launching in 2020, the programme has expanded to take referrals from 85 NHS partners nationally and has supported more than 4,829 participants to complete the programme. The programme continues to reach patients with long COVID and is now also welcoming people with similar post-viral syndromes. ENO Breathe’s ongoing evaluation shows strong health and wellbeing outcomes: 80% of participants reported improved levels of breathlessness, 73% said their anxiety levels had improved, and 80% experienced an improvement in their general wellbeing. Overall, 87% of participants said that ENO Breathe had a positive impact on their general wellbeing. 

Janardhan Rao is a recent participant in the ENO Breathe programme, having joined to support his recovery from long COVID and ongoing respiratory health. He is also an Orthopaedic Consultant in Chester and an Honorary Clinical Lecturer at the University of Liverpool. 
 
Janardhan Rao said, “I have been fortunate enough to be referred into ENO Breathe and I found it transformational. As a doctor who contracted COVID-19 early on, in my line of work, the lasting effects of the disease have been devastating. I had to stop working, as I had real difficulty catching my breath. I could not speak for any length of time and was exhausted continuously.  
 
The ENO Breathe programme helped me get back to work, in ways that I did not expect. I was not a singer, so I did not think that it would be for me. I was breathless all the time, but with the weekly programme of mindful breathing exercises and simple lullabies, I found that I could speak in sentences again. As my breathing improved, I found that I had the energy to go back to work. I am so grateful for this programme.”  

This article has been adapted from a press release from ENO.