Date Published: May 2, 2019
Publisher: Public Library of Science
Author(s): Lia Studer, Desiree M. Schumann, Aline Stalder-Siebeneichler, Michael Tamm, Daiana Stolz, Alexander Larcombe.
The effect a wind instrument has on lung function is a much-discussed topic with inconclusive data, not least because existing studies combine all wind instruments as one entity. The aim of this study was to investigate the effect of playing a trumpet/cornet/flugelhorn on lung function.
A prospective, multicentre, cross-sectional, case-control study. Participants were recruited from wind orchestra or brass bands throughout Switzerland. Inclusion criteria: aged 16 or older, reporting at least one year of playing a trumpet/cornet/flugelhorn. Controls were members of an orchestra, who had never played a wind instrument. The primary end-point of the study was the difference in FEV1%predicted between trumpet/cornet/flugelhorn players and controls.
147 subjects were included in the study. Controls (n = 48) were significantly younger, more commonly male, current smokers and had a lower body mass index compared to trumpet/cornet/flugelhorn players (n = 99). There was no significant difference in FEV1%predicted (91.9% vs 94.2%; p = 0.316) or FVC %predicted (89.4% vs 92.6%; p = 0.125) between controls and trumpet/cornet/flugelhorn players, respectively, in crude and adjusted analyses. However, there was a significant negative association between the number of years playing a trumpet/cornet/flugelhorn and FVC %predicted after adjusting for smoking status, gender, and height. Trumpet/cornet/flugelhorn players had a similar amount of respiratory symptoms to controls (questionnaire score 3.2±3.2 vs 2.8±2.4, p = 0.717).
Lung function in trumpet/cornet/flugelhorn players was similar to controls. However, the number of years playing a trumpet/cornet/flugelhorn seems to have an adverse effect on forced vital capacity.
There is an ongoing discussion whether- and how- playing a wind instrument influences lung function. However, data provided are inconclusive [1–8]. Bouhuys et al. [1, 4] show that professional male wind instrument players have higher vital capacity (VC), total lung capacity (TLC) and forced expiratory volume in 0.75 seconds (FEV0.75) than healthy controls. Stauffer et al.  confirm that wind instrumentalists have higher VC than the established norms at that time. Sagdeo et al.  found a positive correlation between degree of expertise in playing a wind instrument and various lung function parameters such as forced vital capacity (FVC), forced expiratory flow between 25% and 75% of FVC (FEF25-75%), peak expiratory flow rate (PEFR), forced expiratory flow of 50% of FVC (FEF50%), forced expiratory flow of 75% of FVC (FEF75%) and maximum voluntary ventilation (MVV). Kim et al. found an improvement in FVC, forced expiratory volume in 1 second (FEV1) and MVV in elderly women trained for 5 or 10 weeks in playing the ocarina, a closed wind instrument. Both Sagdeo et al. and Kim et al. use lung function in litres and not percent predicted. Conversely, Navratil et al. , Fuhrmann et al. , Schorr-Lesnick et al. , Smith et al. , Fiz et al. , Ksinopoulou et al. , Borgia et al , Brzek et al.  and Bouros et al.  could not establish any difference in lung function between wind instrumentalists and controls. Deniz et al.  report that playing a wind instrument is detrimental to lung function and Zuskin et al.  demonstrate a higher prevalence of sinusitis, nasal secretion and hoarseness in wind instrument players compared to controls. The possible detrimental effect of playing a wind instrument could be due to high-pressure damage to small airways and alveoli, or infection caused by pathogens residing in the instruments [8, 17, 19, 20]. Despite the scarce evidence of its beneficial effect, playing a wind instrument, such as a didgeridoo, is currently recommended as a treatment modality to increase awareness and compliance in asthmatics [21, 22]. A recent review concludes that due to the paucity of reliable data, only a weak recommendation can be made for music therapy in asthmatics .
Between June 2017 and December 2017, 99 trumpet/cornet/fluegelhorn players and 48 controls were included in the study totalling 147 participants from more than 25 different orchestras in Switzerland. Of the 99 trumpet/cornet/fluegelhorn players, 44 played cornet only, 2 played cornet and fluegelhorn, 1 played cornet and trumpet, 6 played fluegelhorn, 1 played fluegelhorn and trumpet, 43 played trumpet only, and 2 played all three instruments. Controls were significantly younger, more commonly current smokers, male and presented a lower body mass index compared to the trumpet/cornet/fluegelhorn players (Table 1). The trumpet/cornet/fluegelhorn players played on average 5.2±4.1 hours per week, had played their instrument for an average of 27±14.4 years and cleaned their instruments once a year.
Uncertainty surrounding the impact of playing a wind instrument on lung function has been ongoing for several years. Various studies combined brass wind and woodwind instrumentalists, hampering the interpretation of results due to the differences in technique and pressure required when playing these instruments [2, 4, 8]. In the present study, the largest of its kind, we therefore, investigated the effect of playing a trumpet/cornet/flugelhorn, a homogenous group of wind instruments, on lung function compared to non-wind instrument playing controls who were also musicians in a brass band.