FLUTTER® Mucus Clearance Device - YUMPU

FLUTTER ® Mucus Clearance Device Instructions for Use PRODUCT DESCRIPTION The FLUTTER ® mucus clearance device is shaped like a pipe with a hardened plastic mouthpiece at one end, a plastic protective, perforated cover at the other end, and a high-density stainless steel ball resting in a plastic circular cone on the inside (Figures 1 and 2). INDICATIONS The FLUTTER ® provides positive expiratory pressure (PEP) therapy for patients with mucusproducing respiratory conditions, including: Atelectasis, Bronchitis, Bronchiectasis, Cystic Fibrosis, Chronic Obstructive Pulmonary Disease (COPD), Asthma or other conditions producing retained secretions. CONTRAINDICATIONS The FLUTTER ® is contraindicated for patients known to have pneumothorax or overt right-sided heart failure. PRINCIPLES OF OPERATION The principle of the FLUTTER ® as a mucus clearance device is based on its ability to: (1) vibrate the airways (which loosens mucus from the airway walls); (2) intermittently increase endobronchial pressure (which helps maintain the patency of the airways during exhalation so that mucus does not become trapped as it moves up the airways); and (3) accelerate expiratory airflow (which facilitates the upward movement of mucus through the airways so that it can be more easily cleared). The FLUTTER ® effect occurs during the expiratory phase of respiration. Before exhalation, the steel ball blocks the conical canal of the FLUTTER ® . During exhalation, the actual position of the steel ball is the result of an equilibrium between the pressure of the exhaled air, the force of gravity on the ball, and the angle of the cone where the contact with the ball occurs. As the steel ball rolls and bounces up and down, it creates an opening and closing cycle which repeats itself many times throughout each exhalation (Figure 3). The net result is that oscillations in expiratory pressure and airflow are produced. When the oscillation frequency approximates the resonance frequency of the pulmonary system, endobronchial pressure oscillations are amplified and result in vibrations of the airways. The vibrations produced by these oscillations cause the "fluttering" sensation from which the FLUTTER ® derived its name. These vibrations loosen mucus from the airway walls. The intermittent increases in endobronchial pressure decrease the collapsibility of the airways during exhalation, increasing the likelihood of clearing mucus from the tracheobronchial tract. The airflow accelerations increase the velocity of the air being exhaled, facilitating the movement of mucus up the airways (Figure 4). The FLUTTER ® produces a range of oscillation frequencies between 6 and 20 Hz, which corresponds to the range of the pulmonary resonance frequencies in humans. Attaining oscillation frequencies in this range is fundamental to the efficacy of the FLUTTER ® . The individual pulmonary resonance frequency of each patient is dependent on many factors, including lung volume, lung elasticity, and degree of airway obstruction. The frequency of oscillation that produces the best transmission of vibrations in a given patient corresponds to the pulmonary resonance frequency for that patient. When the resonance frequency of the pulmonary system is achieved, the pressure variations are amplified, maximizing the vibrations of the airway wall. These vibrations, coupled with increases in expiratory pressure and airflow, facilitate the clearance of mucus. The oscillation frequency produced by the FLUTTER ® when its stem is in the horizontal position is approximately 15 Hz. This frequency can be modulated by changing the inclination of the FLUTTER ® slightly up (higher frequency) or down (lower frequency) from its original horizontal position. Adjusting the FLUTTER ® to the resonance frequency is easily accomplished by the patient who selects the angle tilt that results in the best transmission of vibrations to his/her airways.

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Phlegm has a tendency to get stuck deep in the lungs and despite all your best efforts, you may not be able to cough every last bit out. People living with cystic fibrosis and bronchiectasis produce more mucus than most and removing this is crucial to staying healthy. An overview of airway clearance can be found here.

Flutter or PEP (positive expiratory pressure) valves are simple and effective devices that are usually the first step to helping you to clear the mucus out of your lungs. You may have been given one by your doctor or advised to buy one. They are commonly known by their brand names (Flutter®, Acapella®, Aerobika®, and RC-Cornet®). It doesn’t really matter which one you have as long as you are using it correctly. Let’s take a closer look.

The science behind these valves in simple. When you breathe in, air moves freely into your lungs. When you breathe out into the valve, you will feel resistance (and often vibration). This resistance when exhaling makes you take up to four times as long to breathe out. The effect of this is to open up your airways (similar to what happens when you blow up a balloon) and get air behind mucus stuck in small airways. Oscillating PEP valves create a vibration which will help break mucus free and allows you cough it out. All of the brands mentioned above are oscillating PEP valves (= resistance and vibration).

How to do it:

1. Sit up with a straight back and good posture
2. If you are doing a breathing treatment (such as albuterol) using an inhaler or a nebulizer, do this 10-15 minutes before
3. If prescribed, nebulize a mucolytic breathing treatment (such as hypertonic saline, Pulmozyme® or Mucomyst®) after albuterol.
4. Take a deep breath and hold it for 2-3 seconds
5. Blow out actively through the PEP valve with your lips forming a tight seal around the mouthpiece
6. Repeat steps 4 and 5 for 10 breaths
7. Next perform huff coughs to move mucus from deep within the lungs closer to where you can cough it out (see this post and this 60 second video for an example of huff coughing)

These steps should hopefully make you cough which is what you want. If you find there is still mucus rattling around down there, take a few more deep breaths through the PEP valve. This technique works well in conjunction with high frequency chest wall oscillation (‘vest’ therapy). If you have a percussion vest, you can wear that at the same time as you use the PEP valve. Remember, this is not a one-size-fits-all approach. Your doctor will determine how intensive your airway clearance should be and develop a regimen tailored for you.

PEP valves may not be covered by your insurance and the cheapest place to buy them is from medical equipment companies selling on Ebay, Amazon or other online retailers.

Additional resources:
Confusion to Clarity: The Perfect CBCT 10 Steps to Making the Right

With competitive price and timely delivery, Yixin sincerely hope to be your supplier and partner.

Remember, never share your PEP valve with anyone else to avoid passing on or acquiring new germs.

Aerobika vs. Acapella

The Aerobika is unique in that you can attach a nebulizer machine to it and use medicines (such as albuterol) through it. It can also be dismantled and cleaned between uses. The resistance can also be adjusted near the mouthpiece which changes how hard it is to blow against. Do not use inhaled antiobiotics through the Aerobika.

When cleaning the Aerobika, take it apart according to supplied instructions. It should break down into 4 pieces. Soak these parts in water for 15 mins and rinse with warm water. Shake to remove excess water and allow to air dry. You can put the Aerobika in the dishwasher (top shelf) but I would recommend against this. Rinse between uses and ideally disinfect weekly – this can be done by placing in boiling water (using a steaming basket or colander) for 5 minutes. You can also soak for 5 minutes in 70% isopropyl (rubbing) alcohol or 3% hydrogen peroxide solution for 30 minutes. Rinse thoroughly after disinfecting and allow to air dry. Watch this video on using the Aerobika device.

The Acapella device can also be washed and rinsed as above. They come apart in some form but should never be placed in the dishwasher. The Acapella Choice® dismantles into 4 pieces and can be washed with your choice of dish soap, 70% rubbing alcohol or 3% hydrogen peroxide. Always rinse thoroughly and allow to air dry. The Acapella DM or DH® break down into 2 pieces, the mouthpiece and the body, both of which should be washed as described above. Like the Aerobika, the Acapella devices have a resistance dial which alters how much pressure you breathe against.

Speak to your doctor about which may be best for you.

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