DOES HARMONICA PLAYING IMPROVE OUTCOMES IN COPD PATIENTS?

Abstract

SESSION TITLE: Improving Care in COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 PM - 02:30 PM PURPOSE: 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 a 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 minutes a day, 5 days a week. Participants completed spirometry testing, maximum inspired and expired pressure (MIP, MEP) testing and Six Minute 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 years. All had been smokers previously with a median 40 [quartile 1 = 30, quartile 3 = 40] pack-year history. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) 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 minutes (6MWD) increased by nearly 60 meters (60.55 ± 78.18, p = 0.0280). Median distance improved by 48 meters. SGRQ improved slightly, but not statistically so. CONCLUSIONS: In this small pilot trial, we found that a 12-week harmonica program significantly improved MIP, MEP and 6 MWD 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. CLINICAL IMPLICATIONS: Harmonica playing may be an option for some COPD patients to use in the home for a lung exercise or as an adjunct treatment to be included in pulmonary rehabilitation and better breathing clubs. DISCLOSURES: Speaker/Speaker's Bureau relationship with Monaghan Medical Please note: $1-$1000 Added 02/27/2018 by Mary Hart, source=Web Response, value=Travel No relevant relationships by AAYLA JAMIL, source=Web Response Speaker/Speaker's Bureau relationship with Astra Zeneca Please note: $5001 - $20000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Bohringle Ingleheim Please note: $5001 - $20000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Circassia Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Advisory Committee Member relationship with Novartis Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria Advisory Committee Member relationship with GSK Please note: $1001 - $5000 Added 02/21/2018 by Mark Millard, source=Web Response, value=Honoraria No relevant relationships by Elizabeth Stewardson, source=Web Response No relevant relationships by Kristen Tecson, source=Web Response