November 29, 2017

Breathing easier through music

By playing the harmonica, patients with COPD are learning how to better cope with their condition.

After Richard May plays the first 4 notes of “Row, Row, Row Your Boat” on his harmonica, the rest of the members of his support group at the San Diego Medical Center follow along. The results aren’t perfect, but everyone has fun. And they are learning how to breathe easier and cope better with the anxiety about their condition, chronic obstructive pulmonary disease, or COPD.

May is a retiree who taught piano for 50 years, but is new to the harmonica. He thinks that the benefits he and the other participants with COPD get from these classes make their efforts to learn the instrument worthwhile.

“I practice playing my harmonica every day because I enjoy it,” May said. “The benefits I have seen from the program are that I have increased my lung capacity, I can walk farther, and my self-esteem has risen. That is the best part.

“If you have COPD, you get anxious because you can’t do what you used to,” he added. “When you are around people who have the same ailments, you can identify with them. I am not as depressed as I used to be. And I now have a sense of purpose.”

COPD is the third leading cause of the death in the United States. The personal, social and economic costs of the disease are huge, with annual expenditures of nearly $50 billion, mostly from hospitalizations.

Mounting evidence suggests that physical inactivity is associated with more frequent hospitalizations and increased mortality in COPD, even after adjusting for disease severity.

Harmonicas for healing

The lessons are a part of Harmonicas for Health, a program recently integrated into monthly group visits that are a part of the Walk On! Physical Activity Coaching program.  The 4-year clinical trial is overseen by research scientist Huong Nguyen, RN, PhD, and funded by the Patient-Centered Outcomes Research Institute.

Physical activity coach Editha Medina leads the San Diego group. She is one of several coaches facilitating WalkOn! group visits at Kaiser Permanente medical centers in Southern California.

The coaches, all respiratory therapists, encourage patients with COPD to become physically active in their homes and communities. This can help build their endurance and avoid emergency department visits and hospitalizations.

May read about the Harmonicas for Health program in an article in the Wall Street Journal. He was so impressed by it that he shared the story with Medina.

Medina loved the idea and asked Leah Maddock, who was the Walk On! project manager at the time, to get approval to buy beginner harmonica kits for group members with study funds.

“We need to try to connect with patients in a variety of ways. Harmonicas as therapy sounded like a fun way to do that,” Maddock said.

“It warms my heart to see the enjoyment and hearty laughs the harmonica playing brings to patients. But it is the ‘aha’ moments when they link the breathing techniques we teach with the harmonica playing that really bring it all together,” she added.

“Many patients with COPD also feel lonely and isolated because of their illness,” Nguyen said. “These group visits can facilitate much-needed positive social interaction.”

Learning from each other

The group visits are just one of several components being examined in the WalkOn! study, which will determine the effectiveness of a 12-month, virtual physical activity coaching intervention compared to standard care for COPD patients.

While pulmonary rehabilitation is the “gold standard” for COPD patients, uptake is only about 5 percent nationally. It requires 6 to 8 weeks of onsite physical training, so it’s hard for many patients to fit into their schedules. Walk On! requires only one in-person visit, followed by a year of telephone coaching.

The monthly visits are optional, but the goal is for patients to network and learn from their peers. Research suggests that peer modeling and mentoring is a powerful force for behavior change and exchange of self-care strategies.

Adding Harmonicas for Health to the WalkOn! visits has gotten patients more excited about group meetings and becoming more active.

“I joined the WalkOn! group to improve my health because I was a wreck when I got out of the hospital,” said patient Bill Ross. “I was on oxygen initially, but then I came off of it. When Editha called me about the program, I jumped on it, because it was a way to challenge myself to make myself more fit.

“I went from walking a mile a day to averaging between 5 and 7 miles a day, and I rarely have had to use my rescue inhaler, just my normal inhalers,” he added. “This program gives you a way to set a goal and try to do better.”