Wilbur's Beginning Harmonica Info
The Harmonica and How It Helps Your Lungs

This page provides very basic information for the person with asthma, COPD, (or other lung impairment), who wants to improve their lung capacity. This information works equally well for the elderly, someone temporarily bed ridden, or just about anyone who wants/needs to exercise their lungs. If anything on this FAQ helps you (or someone you know) ....please let me know.

LEGAL NOTE:     I am not a physician; I am only a reasonably well-informed harmonica player. This information is for educational purposes only, and should be used only as a supplement to...not a substitute for...professional medical advice.
  Books BOOK LIST
Introduction
If you (or someone you know) has asthma, COPD, reduced lung function (perhaps after surgery)...you've come to the right spot!!! If you have "none of the above" but you're just curious about what may seem like a strange topic for a "harmonica web page", please read on.   Let me assure you that the information on this page is not strange and in fact is very reasonable....and I hope helpful.
    Quite accidentally I stumbled across an article about physician who "prescribed" the harmonica to several of his patients. This doctor used the harmonica as a method to encourage deep breathing in elderly patients recovering from hospital stays. He found that his patients responded better to the harmonica than to the medical devices he had been sending home with them. After reading this article, it occurred to me that the harmonica could be used not only by elderly patients recovering from surgery, but also by people with asthma, COPD, or some other respiratory problem.
    Asthma and COPD affects millions of people worldwide. It ranges in severity from a minor inconvenience to a major life problem. There are untold numbers of elderly, people recovering from hospital visits, and/or folks with other lung ailments. This page offers information on how to use the harmonica to help increase (or at least maintain) lung capacity and do it in a fun enjoyable way.





What Is Asthma and COPD??
It is beyond the scope of this page to describe asthma or COPD in detail. I will however, offer a very brief overveiw.

What is Asthma:
Asthma is a condition in which the airways of the lungs become either narrowed or completely blocked, impeding normal breathing. However, in asthma, this obstruction of the lungs is reversible, either spontaneously or with medication. Asthma is a lung disease which affects an estimated 100 million people worldwide. It is most prevalent among young children but can occur at any age. In approximately half of the children who have asthma, the first symptoms occur before the age of 10 years. The majority of childhood asthmatics will be rid of the disease by the time they reach adulthood. Asthma can vary from mild cases to severe cases which may require hospitalization. Even in mild asthma cases, it is a good idea to visit a physician.
Quick review...structure of the lung: ....air reaches the lung by passing through the windpipe (trachea), which divides into two large tubes (bronchi), one for each lung. Each bronchi further divides into many little tubes (bronchioles), which eventually lead to tiny air sacs (alveoli), in which oxygen from the air is transferred to the bloodstream, and carbon dioxide from the bloodstream is transferred to the air. Asthma involves only the airways (bronchi and bronchioles), and not the air sacs. The airways are cleaned by trapping stray particles in a thin layer of mucus which covers the surface of the airways. This mucus is produced by glands inside the lung, and is constantly being renewed. The mucus is then either coughed up or swept up to the windpipe (trachea) by cilia, tiny hairs on the lining of the airways. Once the mucus reaches the throat, it can again be coughed up or, alternatively, swallowed.
    Although everyone's airways have the potential for constricting in response to allergens or irritants, the asthmatic's airways are oversensitive, or hyper reactive. In response to stimuli, the airways may become obstructed by one of the following:
  • constriction of the muscles surrounding the airway;
  • inflammation and swelling of the airway; or
  • increased mucus production which clogs the airway.
Once the airways have become obstructed, it takes more effort to force air through them, so that breathing becomes laboured. This forcing of air through constricted airways can make a whistling or rattling sound, called wheezing. Irritation of the airways by excessive mucus may also provoke coughing. Because exhaling through the obstructed airways is difficult, too much stale air remains in the lungs after each breath. This decreases the amount of fresh air which can be taken in with each new breath, so not only is there less oxygen available for the whole body, but more importantly, the high concentration of carbon dioxide in the lungs causes the blood supply to become acidic. This acidity in the blood may rise to toxic levels if the asthma remains untreated.

While modern medicine has many treatment options for asthma symptoms, there is no known (or widely accepted) cure for asthma. Adult asthmatics who do not outgrow the problem, will need to be mindful of their condition and perhaps use medication for life. Because asthma symptoms tend to discourage physical activity..(especially outdoor activity) people with asthma can become more sedentary and thus aggravate the conditions of their lungs. Some amount lung exercise is definitely called for.



What is COPD?
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe airflow obstruction that is associated mainly with emphysema and chronic bronchitis.
- Emphysema causes irreversible lung damage by weakening and breaking the air sacs within the lungs. As a result, elasticity of the lung tissue is lost, causing airways to collapse and obstruction of airflow to occur.
- Chronic Bronchitis is an inflammatory disease that begins in the smaller airways within the lungs and gradually advances to larger airways. It increases mucus in the airways and increases bacterial infections in the bronchial tubes, which, in turn, impedes airflow.
      The exact prevalence of COPD is not well defined, yet it affects tens of millions of Americans and is a serious health problem in the U.S.: In 1994, it was estimated that 16 million patients have been diagnosed with some form of COPD and as many as 16 million more are undiagnosed New government data based on a 1998 prevalence survey suggest that three million Americans have been diagnosed with emphysema and nine million are affected by chronic bronchitis.   COPD is the fourth leading cause of death in the U.S. In 1998 COPD accounted for 112,584 deaths, and an estimated 668,362 hospital discharges.

*** Risk factors for COPD:
Long-term smoking is the most frequent cause of COPD. It accounts for 80 to 90 percent of all cases. A smoker is 10 times more likely than a non-smoker to die of COPD. Other risk factors include:
  • Heredity
  • Second-hand smoke
  • Exposure to air pollution at work and in the environment
  • A history of childhood respiratory infections


Symptoms of COPD:     The symptoms of COPD include: chronic cough, chest tightness, shortness of breath, an increased effort to breathe, increased mucus production, and frequent clearing of the throat.   COPD decreases the lungs' ability to take in oxygen and remove carbon dioxide. As the disease progresses, the walls of the lungs' small airways and alveoli lose their elasticity. The airway walls collapse, closing off some of the smaller air passages and narrowing larger ones. The passageways become clogged with mucus. Air continues to reach the alveoli when the lungs expand during inhalation; however, it is often unable to escape during exhalation because the air passages tend to collapse during exhalation, trapping the "stale" air in the lungs.   A typical course of COPD might begin after a person has been smoking for 10 years, during which symptoms are usually not very noticeable. Then the patient begins developing a productive, chronic cough. Usually, after age 40, the patient may begin developing shortness of breath during exertion, which continues and worsens over time. Though the severity may vary, COPD patients have some degree of airway obstruction. While symptoms may vary over time, the patient will notice a gradual deterioration over the course of four to five years. Repeated and increased productive coughing begins to disable patients, who over time take longer to recover from these attacks.   Many patients with severe COPD-related lung damage have so much difficulty breathing when lying down that they sleep in a semi-sitting up position. For COPD patients, the combination of too little oxygen and too much carbon dioxide in the blood may also have an impact on the brain, and can cause a variety of other health problems, including headache, sleeplessness, impaired mental ability and irritability.
  The clinical development of COPD is typically described in three stages, as defined by the American Thoracic Society:
  1. Stage 1: Lung function (as measured by FEV1 or forced expiratory volume in one second) is greater than or equal to 50 percent of predicted normal lung function. There is minimal impact on health-related quality of life. Symptoms may progress during this stage, and patients may begin to experience severe breathlessness, requiring evaluation by a pulmonologist.
  2. Stage 2: FEV1 lung function is 35 to 49 percent of predicted normal lung function, and there is a significant impact on health-related quality of life.
  3. Stage 3: FEV1 lung function is less than 35 percent of predicted normal lung function, and there is a profound impact on health-related quality of life.
What can COPD patients do to help themselves live as normal a life as possible?
The best weapon against COPD is prevention: avoiding or ceasing smoking. Avoiding smoking almost always prevents COPD from developing, and ceasing smoking slows the disease process.   Pulmonary rehabilitation programs and medical treatment can be useful for certain patients with COPD. The key goal should be to improve physical endurance in order to overcome the conditions that cause shortness of breath and limit capacity for physical exercise and daily activities.

What are the goals of COPD care?    
It is important to identify and treat COPD at the earliest time possible in its natural history. Unfortunately, the diagnosis of COPD is frequently made when patients are in their late 50s or 60s, when FEV1 has declined to a symptomatic range, and when quality of life is rapidly deteriorating. Therefore, the goal of any physician treating patients with COPD is to help relieve their patients' symptoms, to help patients better manage the effects of their disease and to live as full and active lives as possible.   If patients work closely with physicians to develop a complete respiratory care program, they can:
  • Improve lung function
  • Reduce hospitalizations
  • Prevent acute episodes
  • Minimize disability
  • Delay early death
Key components of COPD care:     (in addition to smoking cessation)
Depending upon the severity of the disease, treatments may include...
  • Bronchodilators that open up air passages in the lungs
  • Antibiotics
  • Exercise to strengthen muscles
  • Medications that are prescribed for people with COPD may include:
    • Fast-acting beta2-agonists such as albuterol which can help to open narrowed airways.
    • Anticholinergic bronchodilators, such as ipratropium bromide, and theophylline derivatives, all of which help to open narrowed airways
    • Long-acting bronchodilators, which help relieve constriction of the airways and help to prevent bronchospasm associated with COPD.
    • Inhaled or oral corticosteroids, which help reduce inflammation
      Currently, the role of these anti-inflammatory medications in COPD therapy is not well defined, and they are not yet indicated for COPD in the U.S. However, clinical trials are underway.
    • Antibiotics, which are often given at the first sign of a respiratory infection to prevent further damage and infection in diseased lungs.
    • Expectorants, which help loosen and expel mucus secretions from the airways, and may help make breathing easier.
    • In addition, other medications may be prescribed to manage conditions associated with COPD. These may include:
      • Diuretics, which are given as therapy to avoid excess water retention associated with right-heart failure, which may occur in some COPD patients.
      • Digitalis (usually in the form of digoxin), which strengthens the force of the heartbeat. It is used with caution in COPD patients, especially if their blood oxygen tensions are low, since they become vulnerable to arrhythmia when taking this drug.
      • Painkillers, cough suppressants, and sleeping pills, which should be used only with caution, because they depress breathing to some extent.


People with COPD can better manage their disease by:
Avoiding:     Cigarettes, dust, air pollution, cigarette smoke, and work-related fumes Contact with people who have respiratory infections, such as colds and flu Excessive heat, cold or high altitudes5
Maintaining:     A healthy diet and an exercise program supervised by a health care provider. Regular contact and visits with a health care provider so that he or she can carefully monitor the disease;   this includes having regular spirometry tests.
Additional treatment options for patients with COPD may include:
  • Regular immunizations, such as for flu and pneumococcal pneumonia
  • Pulmonary rehabilitation, which can improve exercise tolerance
  • The use of supplemental oxygen, especially in patients in the later stages of COPD
  • Bullectomy, or surgical removal of large air spaces in the lungs
  • Lung volume reduction surgery, which is currently considered experimental
  • Lung transplantation, which also has proven effective in some end-stage COPD patients




How Can the Harmonica Help??

Anything that improves or maintains lung function also helps reduce asthma and/or COPD symptoms (remember...so far no one has a cure for asthma or COPD). The very nature of playing the harmonica facilitates deep breathing and promotes increases in lung capacity. These are both very desirable things.
NOTE: There is something of a controversy raging in the biking and wall climbing community on whether or not the lungs can be "trained" using specific lung training devices. Some physicians and therapists argue that the lungs are not constructed like muscles and therefore cannot be "trained" as such. Other physicians and therapists argue back that while the lungs themselves may not be "trainable" like a muscle is, the diaphragm and other parts of the body involved in respiration CAN be trained.       While I am not weighing in on either side...let me just point out that plan old facts and results speak for themselves.   It is well documented that lung capacity can be increased by exercise.     Athletes know this.   Musicians know this.      Professional musicians such as trumpet players and saxophonists (to name a few) have acquired (through practice and work) improved lung function. They have all acquired the ability of increased airflow, better control over their ariflow, and more importantly deep breathing and increased lung capacity.

    Playing the harmonica involves long slow draws (inhales), breath control, and awareness of breathing patterns. Some harmonica songs require pretty good lung capacity (for lots of blow notes in a row). Even simple beginning songs on the harmonica facilitates these traits. If you continue to play and improve, odds are that your lung capacity will also improve. If you plan to pursue the harmonica seriously then you will reap many of the lung capacity benefits simply by doing the practicing that proficiency requires. However, even assuming that you don't want to become a serious harmonicist or spend lots of time playing the harmonica, there are ways to use the harmonica to greatly assist improvements in breathing and lung capacity.

Interested??? Read on......

    Medical science has created several gadgets to assist folks with asthma or impaired lung function in checking and maintaining their lung capacity. One of these is the Incentive Spirometer. The Incentive Spirometer comes in several "flavors". The most expensive ones are electronic and hook to computers or other devices to measure and chart breathing. They will measure and graph inspiration (how much air you can suck in) and expiratory flows (how much air you can blow out). Your doctor probably made you blow into one of these things when you went for allergy/asthma testing.     A much less expensive version of the professional level incentive spirometer is also available. This model is made from plastic and is not electronic. It looks like a clear plastic hollow tower (about 8 inches tall) containing a ball or platform inside the tower that rises and falls as you breath in air. A plastic hose attached to the bottom of the tower with a mouthpiece attached to the end of the hose. The tower has markings on it to measure the height of the ball (when you breath in through the mouthpiece) and indicate the amount of air taken into the lungs. Anyone who had surgery and spent more than a couple of days in the hospital may have had one of these things show up on their bed stand (courtesy of your friendly respiratory therapist). These models are often sold for home care and used for patients recovering from surgery, elderly patients, and/or anyone in need of some therapeutic assistance in breathing.

    The harmonica can be used in much the same way the incentive spirometer is used to promote long, slow, deep, breaths. While the harmonica provides no quantitative feedback on how much air you're taking into your lungs and it can't draw charts.....it can definitely help you exercise your lungs, your diaphragm, and all of the supporting muscles. Additionally the harmonica is inexpensive, portable, non intrusive (it doesn't look weird or medical), and you can use it almost anywhere. Most importantly after doing your breathing exercises on the harmonica (perhaps as a warm-up) you can start playing and enjoying the music!!


Tell me How to Use the Harmonica to Help My Lungs??

    First you have to get a harmonica. If you don't have a harmonica, check out the Beginning Harmonica FAQ web page for information on selecting and acquiring your harmonica. If you plan to learn to play music then you may want to shell out $17.95 for a good Lee Oskar or Horner. If you're simply interested in using the harmonica in place of an "Incentive Spirometer" then any cheapie brand will probably suffice.
    Secondly you should learn a few basics of harmonica playing. If you haven't already done so, read the Beginning Harmonica Lessons and Tips web page and pick up the basics of how to hold and get sound out of the harmonica. Once you've done this and can get sound (hopefully notes) out of your harmonica,   you are ready to move forward. Exercising your lungs using the harmonica is relatively straight forward. I will provide a couple of methods to give you the idea and get you started. The goal is to develop deep breathing habits and increase lung capacity.
NOTE: The critical part of these exercises is breath control and long, SLOW, DEEP, breaths. We will use the harmonica to provide aural feedback on how well you're breathing and to provide fun in what some people find a tedious exercise. The key however is still to exhale until the lungs are nearly empty....inhale slowly until they are very full... HOLD FOR A COUNT OF 3 SECONDS...and then exhale and repeat.

Easy Method #1:
  1. Exhale through your mouth until your lungs feel comfortably empty (don't force yourself).
  2. Holding the harmonica in your left hand, put it in your mouth at the middle of the harmonica. (Start at hole #4 or slightly above...see picture #1 below)
  3. Gently draw (inhale) air back through the harmonica until your lungs are full once again. You should hear the pleasant sound of harmonica notes. If you don't inhale with sufficient force you won't get a note. If you inhale too hard you will get "bent" or overdrawn notes that don't sound very pleasant. Let your ears guide you towards long, deep, controlled breaths that create clear steady notes on the harmonica.
  4. Once your lungs are full....hold your breath for a slow count of three.
  5. Remove the harmonica from your mouth and exhale....and then start the process all over again by inhaling through the harmonica.
  6. Repeat this process 15-20 times.
Start in the middle of the harmonica at Hole#4
Picture #1

That's all there is to it!!! If you do this simple exercise twice a day (morning and night) I guarantee that your lungs will respond. Try to increase the amount of time you perform this exercise. Start with 15-20 times and increase to 50-60 times. If it takes 2-3 seconds to inhale, another 3 seconds of holding your breath, and 1-3 seconds to exhale... the whole exercise (at 50-60 repetitions) shouldn't take more than 10 minutes. Ten minutes of deep breathing twice a day is not prohibitive in anyone's schedule.

Intermediate Method #2:

After you've mastered the Easy Method #1...or you're just bored with the hearing the same notes over and over, try Intermediate Method #2. This method will move you to running the scale up and down the harmonica while you inhale and exhale. Be sure to read Beginning Harmonica Lessons and Tips web page to learn the proper embouchure (mouth position) necessary to get a single note to sound on the harmonica.

  1. Holding the harmonica in your left hand, put it in your mouth at the middle of the harmonica. (Start at hole #4 which is "C" and the beginning of the "C Scale" ...See picture #1 above)
  2. Using only one breath, Gently blow (exhale) through the harmonica starting on hole#4 and then move your mouth up the harmonica one hole at a time continuing to blow single notes until you run out of air and you no longer get sound from the harmonica. If you get to the top note and still have air left, don't stop, just move back down the scale until you run out of air. This time you can use your stomach muscles to force a little extra air out of your lungs at the very end.
  3. Leave your mouth on whatever hole you were on when you ran out of air, and Gently draw (inhale) air back through the harmonica. Once again move your mouth up/down the harmonica scale, one hole at a time until your lungs are full. You should hear the pleasant sound of harmonica notes. If you don't inhale with sufficient force you won't get a note. If you inhale too hard you will get "bent" or overdrawn notes that don't sound very pleasant. Let your ears guide you towards long, deep, controlled breaths that create clear steady notes on the harmonica.
    NOTE: Don't try to blow/draw on Holes #1, #2, #3. Start on hole #4 going up the scale and when you get back to hole #4 start back up the harmonica again.
  4. Once your lungs are full....hold your breath for a slow count of three...and reposition your mouth over Hole #4.
  5. Start the process all over again by exhaling through the harmonica.
  6. Repeat this process 20-30 times.
NOTE: At first you may find that after exhaling completely, you need to get air back into your lungs faster than the harmonica will allow. If so simply take the harmonica out of your mouth and gasp in some air. Then go back to step #1 and try again. Eventually (hopefully very quickly) you will be able to "breathe" through your harmonica..taking long deep inhales and exhales.

You can use Intermediate Method #2 to measure progress. By using a steady rhythm and getting a good single note sound, you can count how many notes you get on one breath. Because you are exhaling through the harmonica (rather than removing the harmonica from your mouth as in Easy Method #1), this exercise prolongs the among of time between breaths...which will force the previously unused airways in the lungs to open up and work.     An additional musical benefit is that you learn to move the harmonica in your mouth while maintaining sound and good single notes. (The ability to play single harmonica notes is mandatory to make progress on the harmonica).

Advanced Method #3:

After you've mastered the Intermediate Method #2...you're ready for a challenge. So far we've ignored Holes #1 #2 #3...and there's a reason for that. The lower three holes require more precise air pressure to get good sound than holes #4 thru #10. While it isn't overly difficult to get holes #1 #2 #3 to sound on exhale (blow) it is somewhat difficult to get a good sound from them on inhale (draw). Hole #2 in particular is a difficult note to play. It takes good breath control, a steady draw (inhale), and just the right amount of air pressure to get the #2 Draw to sound right. If you're ready.....do Advanced Method #3

  1. Holding the harmonica in your left hand, put it in your mouth on Hole #2 (...See picture #1 above)
  2. Using only one breath, Gently blow (exhale) through the harmonica on Hole #2. Experiment with the air pressure needed to get a good sound. Just like previous methods...blow until you run out of air and can't get sound from the harmonica. This time you should use your stomach muscles to force a little extra air out of your lungs at the very end.
  3. Leave your mouth on Hole #2, and Gently draw (inhale) air back through the harmonica until your lungs are full. You'll have to experiment a bit to find the right amount of inhale (draw) pressure to use. Hole #2 is very unforgiving and if you use too much or too little air you will not get a good sound. Be prepared for squeaks, vibrations, and sometimes no sound at all from the #2 draw. Breathe from your diaphragm and let your ears guide you towards long, deep, controlled breaths that create a clear steady note on the #2 draw. Feel the note resonate in the back of your throat and down in your stomach.
    NOTE: The higher scale notes (hole #4 - #10) are fairly forgiving notes in that they resonate pretty well at varying air pressures. The lower scale notes (hole #1 #2 #3) require more precise breath control.
  4. Once your lungs are full....hold your breath for a slow count of three.
  5. Leaving your mouth on Hole #2, Start the process all over again by exhaling through the harmonica.
  6. Repeat this process 20-30 times.



What is "DEEP" Breathing

    Let's take a look at "deep" breathing.     First....deep breathing is NOT simply puffing out your chest. Expanding the chest is indeed helpful (and desirable), but DEEP" breathing actually starts in your stomach and diaphragm. The ribcage and it's supporting bone and muscle structure protects the heart, lungs, etc......AND that same bone/muscle structure limits how much air a person can take in if he/she is simply "puffing out" their chest. To get real improvement in lung capacity, you MUST learn to breath from your stomach and diaphragm.       This concept is not new. Singers, musicians, swimmers, and a whole lot of other people have been doing this for years. Here are some guidelines for practicing deep breathing.

  • Remember...deep breathing comes from your stomach and diaphragm.
  • When you "deep breathe", your stomach should expand (move out) on the inhale and move back in on exhale.     Feel your stomach area (diaphragm) expand outward.
  • Your stomach should move BEFORE your chest does.
  • When you inhale (take in a deep breath), your stomach should move first
    - your chest should start to expand only AFTER you stomach /diaphragm have reached their limit.
    When you exhale your stomach should move first...pushing air out of your lungs.
    - Use your chest to expel the rest of the air AFTER your stomach and diaphragm have already done their work.
  • Visualize filling the very lowest portion of your lungs with air.
  • Practice deep breathing standing up. If you use good upright posture and practice while standing, you should almost feel the air going into and coming from, your diaphragm.
  • Stand sideways in front of a mirror and take deep breaths. You should see your stomach move out on deep inhales and go back in on exhales.
  • Do this until you can regularly reproduce the physical actions of deep breathing.



Some Last Thoughts and Additional Info

There are lots of ways to use the harmonica to increase lung capacity and to facilitate deep breathing. You can use the methods provided here or make up your own. Just remember the basic concepts.

  • Exhale until lungs are comfortably empty.
  • Inhale using a long, SLOW, DEEP, breath.
  • FEEL your lungs expand on the inhale...deep breath from your diaphragm.
  • Hold the air for a count of 3 seconds
  • Slowly exhale....and repeat
If you get serious about playing the harmonica, you can use these exercises as part of your warm-up routine. I hope that performing these exercises will whet your appetite for playing the harmonica and you will pursue it into the wonderful world of music.

Use Common Sense
If you have exercise induced asthma...start out slow and easy on the breathing exercises and increase gradually.

Don't do dumb things like sit outside on the porch in the early morning doing deep breathing exercises on the harmonica when the pollen counts are at their highest.

Follow the breathing guidelines and don't rush your breathing.

Increase the amount of air you take into your lungs, inflate those puppys....stretch that ribcage....use that diaphragm... but use a little brain power while doing it.

You can do these exercise almost anywhere...including your car on the way to work or to the store. If you perform these exercises in the car...drive safely and pay attention.

If you have any doubts or questions consult your physician.

Last but most certainly not least... these techniques can be used by ANYONE who wants to increase lung functioning. This could be useful for the elderly or for someone recovering from extended illness, as well as for those suffering from asthma or COPD.



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