By Denise Williams | News & Views

Playing harmonica is simple and fun, and – as pulmonary rehabilitation professionals are increasingly noticing – it may even have therapeutic value.

Just ask Denise Camaraza, RRT, CPFT, of CentraState Medical Center in Freehold, New Jersey. In her role as pulmonary clinical coordinator, she also has the pleasure and privilege of coaching a small group of program participants on how to manipulate the handheld wind instrument. Using a basic model with 10 holes, players breathe in on certain notes and breathe out on others. “You’re inhaling on certain beats and then you’re exhaling for a certain amount of time, but it’s controlled,” Camaraza explains. The measured blowing not only creates music, but also exercises the respiratory muscles and trains them for better breathing, she says. Camaraza – along with other PR professionals – compares it to the standard pursed lip breathing technique commonly taught in PR. And if pursed lip breathing works, she surmises, why wouldn’t harmonica?

Not Just Blowing Hot Air

At CentraState Medical Center, Camaraza shares, some patients in her class showed improvement in their pulmonary function tests after practicing harmonica. That’s in line with findings from a sprinkling of research studies, including one published in 2020 that documented better outcomes in COPD patients who trained on the harmonica for at least two hours per week over the course of three months. Those individuals increased both maximum inspired pressure and maximum expired pressure, and they also logged more distance during the six-minute walk test.¹ A preprint published in 2021, meanwhile, concluded that harmonica playing more effectively controlled breathing and facilitated airway clearance in a small group of patients with COPD.²

Not every study has demonstrated the benefits of harmonica playing in the PR population, however. In one of the earliest investigations, researchers in 2012 found no difference in the clinical, psychosocial and/or functional status of study participants who underwent conventional PR versus those who additionally practiced on the harmonica for 5-20 minutes per day, five days a week.³

That’s certainly not enough to dim Camaraza’s lofty view of harmonica therapy, her own experience telling her that the activity certainly can’t hurt her patients. Anything that motivates them to regularly work their respiratory muscles and improve their breathing is sure to alleviate shortness of breath and prevent COPD from worsening, she reasons. And the benefits don’t stop there. The social aspect of the group is also very important, Camaraza notes. Her center’s goal is to graduate PR participants and have them begin exercising on their own at a gym, but the staff often encounter resistance. “Nobody really wants to leave because they’ve developed friendships and they just feel more comfortable coming to pulmonary rehab,” she explains. “They don’t want to go to a gym with their oxygen, where it’s more intimidating to be around people who are fit and can run on a treadmill while they’re walking at a speed of 1.0. Harmonica is another way that we have them together socializing, and it helps improve their breathing at the same time.” It’s not intended as a substitute for exercise, Camaraza emphasizes, but as a fun adjunct to it.

Other advocates share her view, including the COPD Foundation, which in 2016 began supplying PR programs with starter kits to introduce harmonica therapy to their centers. In addition to the multiple benefits already mentioned – exercising the respiratory muscles, breathing better, mitigating shortness of breath, increasing sputum mobilization, socializing and improving quality of life – the COPD Foundation website also lists stronger abdominal muscles for more effective cough, stress relief and higher self-confidence as additional payouts.

The Band’s Back Together Again

Camaraza ordered her starter materials in 2016 and got the therapy group at CentraState Medical Center up and running. “We all kind of learned together,” she says, admitting that getting the hang of harmonica might be a little difficult at first. But even when blowing in and out on the wrong note, Camaraza adds, controlled breathing is still in effect and the lungs are still being put through the paces. And, as with anything, she says playing harmonica gets easier with concentration and practice. “Anybody can do it!” she insists, “AND it’s fun!”

Before long, her pupils took on a name – the Pulmonaires – and began showing off their skills in public. They received standing ovations at CentraState’s internal conferences and Tri-State Society for Cardiovascular and Pulmonary Rehabilitation (TSSCVPR) meetings, often inspiring other programs to explore adding a similar class to their own centers. The performers even entertained before the American Lung Association and set up in the lobby of CentraState Medical Center during the holidays to play seasonal favorites. The video below captures one of their performances.

The COVID-19 pandemic then swooped in and pushed everything, including the Pulmonaires, to the back burner when the rehab was forced to close. Although the shutdown only lasted about six months, continued pandemic restrictions kept the harmonica group in the wings until about two months ago. Camaraza is working with a fresh crop of four new players, and she expects participation to grow once the public health emergency is lifted in May and patients are welcomed back to the hospital without masks.

REFERENCES

1. Hart et al. Usefulness of harmonica playing to improve outcomes in patients with chronic obstructive pulmonary disease (2022). Baylor University Medical Center Proceedings, 33(2); 178-182. https://doi.org/10.1080/08998280.2019.1704135
2. Lewis et al. Playing the harmonica with chronic obstructive pulmonary disease (2022). A qualitative study. Chronic Respiratory Disease, 19. https://doi.org/10.1177/14799731221083315  
3. Alexander et al. Is harmonica playing an effective adjunct therapy to pulmonary rehabilitation? (2012). Rehabilitation Nursing Journal, 37(4); 207-212. doi: 10.1002/rnj.33