Before the music can begin, the harmonica teacher makes sure everyone is in position. "Sit up straight. Feet on the floor. Try to breathe from the belly," she says.
And then, with a burst of sound that is just shy of melodious, the students exhale through the instruments for a long count. They breathe in, out, then in a bit longer, then out a bit longer. After a while, they turn the page of their sheet music books to "Mary Had a Little Lamb," a song they perform with aplomb.
But how well they play "Mary Had a Little Lamb" - or "The Old Grey Mare" or "Good Night Ladies" - isn’t the point of the class at all. Indeed, one student cheerfully admits that she is tone deaf and has no sense of rhythm.
The students are members of a pulmonary rehabilitation class at the University of Michigan Health System. The weekly harmonica instruction is one way that people with chronic obstructive pulmonary disease (COPD) can focus on their breathing in a way that improves their respiratory function, says a pulmonary specialist at UMHS.
"In patients with COPD, even moderate but certainly more severe COPD, each breath is something they have to focus on. They have to understand what they can and can’t do within the course of the day, based on their breathing," says Fernando J. Martinez, M.D., professor of internal medicine in the Division of Pulmonary and Critical Care Medicine.
"Playing the harmonica in the rehabilitation group requires a slow breath in and out to be able to modulate the tones that are coming out of the harmonica, so that the harmonica playing in itself requires the individual to focus on what they’re doing with their respiratory pattern," says Martinez, also the director of Pulmonary Outpatient Services, the Pulmonary Function Laboratory and Lung Transplantation at UMHS.
It’s not as easy as just playing a few notes every now and then. Students in the harmonica class say they have noticed a marked improvement in their respiratory function - but only after doing regular breathing exercises with the instruments.
"It has really helped with deeper breathing and strength, and my pulmonary function tests are much more stable," says participant Christine Lakin. "So something is working - it’s great, and I love it."
"I’ve noticed an enormous difference since I started the class, which was brought home to me when I decided that I enjoyed the harmonica so much I didn’t hate practicing," laughs student Doris West.
People with COPD can take other actions to improve their respiratory function, experts say. Breathing exercises - with or without the use of a harmonica - are common recommendations from lung specialists, as are various medications and oxygen therapy. Martinez also recommends remaining as active as possible.
The most important thing they can do is to stop smoking and to avoid exposure to cigarette smoke. "Cigarette smoking is the biggest risk factor for COPD in the United States," Martinez says.
For many people in the harmonica class, though, the best therapy of all involves their weekly get-togethers.
"We love playing, and we get laughing over our mistakes. Our teacher is the only one that really can play it," participant Rhea Adgate says. "This is our social group. We love it to pieces."
More about COPD and breathing exercises:
- Chronic obstructive pulmonary disease (COPD) is permanent obstruction of airflow from the lungs. This disease causes loss of lung function.
- COPD is the most common respiratory cause of death in the United States and was the fourth leading cause of death overall in the United States in 2002, behind heart disease, cancer and stroke.
- COPD generally results from chronic bronchitis or pulmonary emphysema caused by smoking. The disease usually develops over time and occurs most often in people over age 45 who smoke and/or live where air pollution is a problem.
- In addition to treatments involving medication, other ways of improving symptoms of COPD include exercise, oxygen therapy, and breathing exercises.
- People with COPD also can improve their symptoms by avoiding irritants such as smoke, air pollution, and extreme variations in temperature and humidity; being as active as they comfortably can; getting plenty of sleep; and learning to use relaxation techniques to reduce anxiety and fear.