In an interview with HCPLive, Kevin Nauer, RN, and Becky Jordan, MD, discussed the benefits of pulmonary rehabilitation, and more specifically, the harmonica therapy offered at Allegheny Health Network's (AHN) West Penn Hospital.
Nauer and Jordan shared their roles in the pulmonary rehabilitation program and explained the challenges and successes that come with it.
Kevin Nauer, RN: I'm a nurse and an exercise physiologist, and the manager of pulmonary rehab for Allegheny Health Network. I’m also the COPD coordinator and I work with lung transplant patients.
We have always been looking for different ways to encourage pulmonary rehab for our pulmonary patients–primarily patients with COPD. This is a large group of patients in the area we serve throughout Western Pennsylvania.
COPD is probably still the 3rd leading cause of death in the US, barring COVID-19 in the last few years. We serve a large population, and I think many of our patients truly benefit from interventions that are outside of the norm of inhaled medications and procedures.
We have 5 pulmonary rehab facilities in 5 of our hospitals, and many of our providers, especially pulmonary providers, refer a lot of patients to that program. Becky can also elaborate on challenges like COVID-19 and barriers like transportation, copay costs, and patients with other comorbidities. Many patients do not engage in pulmonary rehab for those reasons. They can't get there, they can't afford copays, or they have problems at home that prevent them from leaving their home, etc.
This prompted us to always look for new ways we could get the program to them.
Virtual pulmonary rehab has been something that many different organizations and healthcare systems have been trying to establish, but it has its challenges. One of the main challenges is reimbursement. Currently, virtual pulmonary rehab is not a reimbursable service, so it's difficult to get patients approved.
We work with an organization called the COPD Foundation. It is a nonprofit organization that helps patients with COPD, raises money, conducts research, etc. They developed the Harmonica Custom Health Program in 2016.
Through them, we were able to create a pilot process or a program where we could obtain that program and materials, including harmonicas, for 15 of our patients, which is currently who we're working with now.
Becky Jordan, MD: I'm a respiratory therapist at West Penn Hospital. I've been at the hospital for 20 years, focusing solely on pulmonary rehab for the past 7 years. It's something I fell into, but it fits my forte and I really enjoy it.
The pulmonary rehab program includes exercise on a treadmill, recumbent bikes, arm odometers (like a bicycle for your arms), free weight exercises, stairs, and a rowing machine. The harmonica program is an added feature of the pulmonary rehab program.
After exercising in the gym, patients come to a separate room to participate in a harmonica session with a small group (usually 3 people) where we laugh and play harmonicas for about 20 minutes.
Playing the harmonica has a therapeutic effect because of the pursed lip breathing technique it requires.
The patients love it. It gives a fun aspect to rehab, something they're proud of. They smile ear to ear when they know it's harmonica day. They pull their harmonica out of their pocket or purse and get very excited about it.
When you play the harmonica, what you're doing is blowing into each one of the ten holes on the top of the harmonica. We teach our COPD patients–and all of our patients with any type of breathing condition–a breathing technique called "pursed lip breathing."
With pursed lip breathing, you breathe in through your nose and exhale out through pursed lips, as if you're blowing out birthday candles. When you're playing the harmonica, that mimics pursed lip breathing completely. I never thought about it that way until we started the program.
Pursed lip breathing gives COPD patients a longer exhalation, allowing them to exhale out bad air for a little bit longer before taking the next deep breath in. It also prevents alveoli, which are sacs in the lungs, from collapsing completely. With COPD patients, it's harder for them to inflate their lungs.
Pursed lip breathing allows for a long, slow exhalation so those sacs don't fully close, making it easier for them to get oxygen and air into their lungs.