A randomized trial in Türkiye found that a structured laughter routine reduced breathlessness in people with chronic obstructive pulmonary disease about as effectively as pursed-lip breathing, the technique clinicians have taught for decades. The effect was still present a month after the eight-week program ended.
The comparison is what makes the result worth reporting accurately. This was not laughter beating standard care. It was laughter performing similarly to an established exercise, with both outperforming a group that did no breathing exercises. Reading it as superiority inverts the finding.
The trial enrolled 63 people with COPD being treated at Ankara Bilkent City Hospital, randomly assigning one third to laughter therapy, one third to pursed-lip breathing, and one third to no breathing exercises. Results were presented at the European Respiratory Society Congress in Barcelona by Dr Goncagul Aldan, a lecturer and nurse who graduated from Hacettepe University Faculty of Nursing in Ankara.
The Routine Participants Were Actually Taught
Laughter therapy in this trial was a specific protocol rather than watching comedy. Participants learned rhythmic clapping paired with vocal sounds, playful exercises such as mimicking a motorcycle starting or a lion's roar, a laughter meditation involving spontaneous unforced laughter, and a closing relaxation with calm breathing and smiling.
Both groups were taught their assigned technique face-to-face in a single session, then asked to practice at home for 30 minutes, three times a week, for eight weeks, supported by a video call and text messages. The trial is registered on ClinicalTrials.gov under the identifier NCT05997550 and was sponsored by Yuksek Ihtisas University.
Pursed-lip breathing, the comparator, involves breathing in through the nose and out slowly through pursed lips. Aldan explained the mechanism in terms clinicians use routinely. In COPD, the airways tend to collapse during exhalation, trapping stale air, and pursed-lip breathing creates gentle back pressure that helps that air escape while slowing the breathing rate.
Results Held for a Month, with One Clear Null
Both interventions significantly reduced the severity of breathlessness compared with no exercises, and the improvement persisted a month after the program finished. Both groups also had better overall health status.
One outcome did not move. Neither intervention changed care dependence, meaning the daily help participants needed did not measurably shift. That null result is a useful boundary on what an eight-week home exercise program appears able to do, and it is the kind of detail that tends to disappear from secondary coverage.
Aldan was candid that the reasons are unclear. She suggested laughter may exercise the breathing muscles, promote deeper exhalation and trigger endorphin release, offering physical and emotional relief. She also said, "The mechanisms behind laughter therapy in COPD remain poorly understood."
Reading a 63 Person Trial Properly
Sixty-three people split three ways leaves roughly 21 per arm. That is small enough that a single unusual participant can shift a group average, and it is far too small to detect differences in outcomes that matter most in COPD, such as exacerbations, hospital admissions, or survival.
The trial was single blind, with blinding maintained for the people administering the assessment scales and analyzing the data, which is the practical limit for an exercise study. Participants obviously knew whether they were laughing on purpose or breathing through pursed lips, and breathlessness is a self-reported symptom, so expectation effects cannot be excluded. The design did address this partially. According to the study record from Hacettepe University, the control group was attention-matched, receiving face-to-face education about lung structure and function plus a printed brochure rather than simply being left alone.
The findings were presented as a conference abstract and have not been published in a peer-reviewed journal. All participants came from a single hospital in one country, and enrollment required a COPD Assessment Test score of 10 or higher, meaning the results describe more symptomatic patients rather than the full range of disease severity.
None of this makes the result uninteresting. It makes it a signal that warrants a larger trial rather than a change in care. Dr Marc Miravitlles, vice president of the European Respiratory Society and a consultant at Vall d'Hebron University Hospital in Barcelona, who was not involved in the research, called the results promising while describing the scale plainly. "This is a small but well-run study," he said.
The Practical Value for People Living with COPD
Nearly 16 million American adults have been diagnosed with COPD, and for them the useful part of this study may be less about laughter than about what it implies. Pursed-lip breathing already works, costs nothing and requires no equipment, yet a substantial share of patients never learn it properly or stop doing it because it feels clinical and tedious.
If a technique patients find enjoyable produces comparable symptom relief, the practical gain is adherence. A home exercise that someone actually continues for eight weeks is worth more than a better one they abandon in two.
Neither technique substitutes for inhaled medication, pulmonary rehabilitation, vaccination or smoking cessation, which remain the interventions with the strongest evidence for changing the course of COPD. Miravitlles made the same point, describing inhaler treatment, exercise and vaccination as the usual core of care.
Anyone with COPD who wants to try either technique can reasonably do so, ideally after asking a clinician or respiratory therapist to demonstrate proper form. Pulmonary rehabilitation programs, which combine supervised exercise with education, are covered by Medicare and most commercial insurance for people with moderate to severe COPD and remain underused. A referral is often the more consequential conversation, and national COPD statistics show how large the untreated gap is.
Nobody should reduce or stop prescribed COPD medication based on this trial. Worsening breathlessness, increased sputum, changes in sputum color or a fever are signs of an exacerbation and warrant prompt medical attention rather than more home exercises.
Larger trials would need to confirm the effect and test whether it holds across disease severities. The research team said it hopes to study laughter therapy on a larger scale and across several countries, and further results would be presented at future ERS congresses.
Key Questions Answered
What did the trial compare? Sixty-three people with COPD were randomly assigned to laughter therapy, pursed-lip breathing exercises, or no breathing exercises, for 30 minutes three times a week over eight weeks.
What were the results? Both laughter therapy and pursed-lip breathing significantly reduced breathlessness severity compared with no exercises, and the effect persisted one month after the program ended.
Was laughter better than the standard exercise? No. It performed comparably to pursed-lip breathing. Both beat doing no breathing exercises.
Did anything not improve? Care dependence did not change with either intervention, meaning the daily help participants needed was unaffected.
What did laughter therapy involve? Rhythmic clapping with vocal sounds, playful exercises such as mimicking a motorcycle or a lion's roar, laughter meditation, and closing relaxation with calm breathing.
How reliable is a 63-person trial? It is small, with roughly 21 people per group, and blinding covered only assessment and analysis. It supports a larger trial rather than a change in treatment.
Should anyone change COPD treatment based on this? No. Inhaled medication, pulmonary rehabilitation, vaccination, and smoking cessation remain the core of COPD care. These techniques are additions, not replacements.
