A-Z List


Clinical Considerations of Pulmonary Status When Considering Applications of Harmonica for Patients with Variety of Diagnoses 

Obstructive lung disease: increased resistance to air flow which may be inside the lumen, in the wall of the airway, or in the peri-bronchial region


Restrictive lung disease: expansion of the lung is restricted either because of alterations in the lung parenchyma  (functional parts as opposed to tissue) or disease of the pleura (membranous lining of the upper body cavity and covering for the lungs) of the chest wall 


Chronic bronchitis – excessive mucus is secreted in the bronchi, the 2 large tubes that branch off into the lungs from the windpipe (trachea) – airways become more narrow and are partially clogged by excess mucus which is not moved along in the normal way by the cilia, tiny hairs that line and cleanse the airways

Goal: prevent obstruction, keep airways as clear as possible – open airways, thin mucus

Coughing helps remove mucus.


Asthma – increased responsiveness of the trachea and bronchi to various stimuli, such as pollutants, allergens, and infectious agents  - smooth muscles in walls of bronchii tighten (bronchospasm) and space available for air decreases – a thick mucus with many white blood cells of eosinophil type enters narrowed pathway, further obstructing air flow – mucus membranes then become swollen


Lungs in normal state: Air comes into the body through the nose or mouth, goes through the windpipe into all the airways, reaches tiny air sacs - oxygen gets into the blood


Lungs in asthma state: very little air gets through because muscles in the walls of airways tighten and constrict, inside walls of airways swell up, swollen walls give off mucus which clogs the airways


Deep breathing exercises are helpful.


Pulmonary function tests estimate degree of airway obstruction:
FEV1/VC ratio = comparison of maximum volume of air a child can forcibly exhale in one second  (forced expiratory volume) with the volume of air completely exhaled following maximum inhalation (vital capacity)
Potential research area – compare patient’s results before and after treatment with a bronchodilating agent with results before and after harmonica therapy
PEFR = peak expiratory flow rate
MMEF = maximal midexpiratory rate


In addition to these tests which estimate degree of airway obstruction, other tests are used to measure TLC = total lung capacity, FRC = functional residual capacity, RV = residual volume, and airway resistance.


A major advantage of harmonica in terms of treatment options: not as much danger of side effects


Side effects of drugs used to dilate the bronchi include nausea, vomiting, irritability,and tachycardia (rapid beating of the heart = greater than 100 bpm in adults). Brochodilators (substances that dilate the bronchi and bronchioles, decreasing airway resistance and thus increasing air flow), may also cause CNS (central nervous system) stimulation, cardiovascular side effects such as arrhythmia, hand tremors, allergic rhinitis, or eczema.


Use of expectorants is controversial.


Antihistamines may have adverse effects, including drying mucus membranes of the airways.  Sedation may increase airway obstruction, depress respiratory centers, and worsen gas exchange which is already impaired.


Corticosteroids may hinder growth and result in cataracts, metabolic disorders, increased susceptibility to infection, and emotional problems. When given in aerosol form, they may cause Candida.


Potential complication of ventilator therapy: pneumothorax - air leaking out of lung
Potential risk for harmonica use: pneumothorax – also a risk with pursed lip breathing
Accessibility for patients on Ventilator Assistance – fenestrated trachs and Passy-Muir valves


Infection control considerations


PULMONARY PHYSIOLOGY:


Central controllers of ventilation include the cortex and the pons.
Sensors = medulla – central and peripheral
Mechanisms of lung expansion – movement of the diaphragm, intercostal muscles (groups of muscles between the ribs that help form and move the chest wall), abdominal muscles, accessory muscles of respiration


Frequent suctioning of patients on ventilators may lead to an increase in secretions.