The Effect of Harmonica-Based Breathing and Airway Clearance Exercises on Pulmonary Function in Children With Cystic Fibrosis: A Randomized Controlled Trial Publisher



Tavasoli H ; Rajabi MM ; Sadat Hoseini AS
Source: Journal of Pediatric Nursing Published:2026

Abstract

Purpose To determine the effect of harmonica-based breathing and airway clearance exercises on pulmonary function in children with cystic fibrosis (CF). Methods This randomized controlled trial included 70 children with CF aged 8–18 years. Participants were randomly assigned to intervention and control groups. The intervention group performed harmonica-based breathing exercises and airway clearance techniques in addition to routine care. The control group received routine care only. The intervention was performed twice daily for 15 min over two months. Primary outcomes were forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC), measured at baseline and two months post-intervention. Data were analyzed using SPSS version 25. Results The groups did not show a statistically significant difference in FEV₁ ( P = 0.38) and FVC ( P = 0.91) at the pre-test. During the intervention, six participants were excluded; therefore, the final analysis was conducted on 64 participants. The results of the ANCOVA revealed that the intervention group exhibited a significant improvement in FEV₁ compared to the control group post-intervention ( P = 0.002). However, no significant changes were observed in FVC ( P = 0.13). Conclusion Harmonica-based exercises significantly improved FEV₁. They may serve as a practical, low-cost adjunct to routine airway clearance in children with CF. The lack of significant FVC improvement suggests that longer intervention periods may be needed to enhance lung volumes. Practice implications Harmonica-based exercises can serve as an adjunct to routine airway clearance in children with CF. Copyright © 2026. Published by Elsevier Inc.