Harmonica Playing Improves Outcomes in Patients With COPD

Abstract

Background: Primary interventions in COPD include smoking cessation, appropriate inhaler therapy and pulmonary rehabilitation (PR). PR requires a multidisciplinary approach of exercise and education, with instruction in breathing retraining exercises such as pursed-lip and diaphragmatic breathing. Pursed lip breathing may reduce alveolar collapse during exhalation and diaphragmatic breathing may work to improve inspiratory pressures, even at the higher lung volumes seen in COPD. Harmonica playing requires the practice of a similar expiratory maneuver as taught in pursed lip breathing (PLB); diaphragmatic breathing generates adequate force to create musical tones. The purpose of this study was to determine if patients with COPD would benefit from a 12-week program of harmonica playing with improved respiratory muscle strength, ambulation and quality of life.

Methods: COPD patients who had completed our formal pulmonary rehabilitation program (PR) at least 6 months prior were eligible for this trial. After obtaining informed consent, patients attended 12 weeks of harmonica training for two hours, one day per week and were instructed to practice at home for at least 30 min a day, 5 days a week. Participants completed spirometry testing, maximum inspired and expired pressure (PImax, PEmax) testing and 6-min walk test pre- and post- program in addition to recording pre- and post-program St. George Respiratory Questionnaires. We performed paired t-tests and Wilcoxon Signed-Rank Tests, as appropriate.

Results: Of the 14 participants upon entry, 11 completed this trial. 3 subjects were male. The average age was 72.5 y. All had been smokers previously with a median 40 (quartile 1 = 30, quartile 3 = 40) pack-year history. Maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax) increased by an average of 15. 36 ± 12.04 (P=0.0017) and 14.36 ± 13.76 (P=0.0061), respectively. Additionally, the distance walked in 6 min (6MWD) increased by nearly 60 m (60.55 ± 78.18, P= 0.0280). Median distance improved by 48 m. Full study outcomes are provided in Table 1. SGRQ improved slightly, but not statistically so.

Conclusions: In this small pilot trial, we found that a 12-week harmonica program significantly improved PImax, PEmax and 6MWD in a group of post-PR COPD patients. Larger scale harmonica studies are warranted to evaluate this program's adjunctive potential benefit to formal pulmonary rehabilitation.