![]() ![]() 4 PEP develops in the range of 10–25 cm H 2O at an oscillatory frequency of approximately 15 Hz. As the subject exhales through the Flutter, the steel ball is intermittently displaced, causing oscillations of air flow and PEP, which are transmitted down the tracheobronchial tree. The Flutter ($68) is a pipe-like device with a hardened plastic mouthpiece at one end, a protective perforated cover at the other end, and a high-density stainless steel ball resting in a plastic circular cone on the inside ( Fig. 9 The frequencies for the Lung Flute are also similar to those for the Flutter however, these 2 devices have never been compared. 4, 7 In addition, studies using the Flutter found that oscillatory waves with varying frequencies are transmitted through the airways, resulting in shearing forces that reduce viscoelasticity of bronchial secretions 8 and easier transportation. The pressure generated by PEP during expiration stabilizes airways, assists mucus movement, and prevents airway closure, thereby improving ventilation. 6 The Flutter (Aptalis Pharma, Bridgewater, New Jersey) and the Lung Flute (Medical Acoustics, Buffalo, New York) are 2 commercially available intrathoracic oscillatory positive expiratory pressure (PEP) devices designed to augment sputum expectoration. ![]() Several airway clearance devices are commercially available to aid in sputum expectoration and optimizing outcomes, but to date, no single device has demonstrated clear superiority. 4, 5 Any effective secretion clearance regime needs to be able to be performed independently, be integrated into normal daily activities, and be cost-effective. 3 Active-cycle-of-breathing technique, gravity-assisted drainage, and manual techniques are often difficult for elderly patients and those with severe disease due to comorbidities and reduced respiratory muscle and cough strength. 2 These techniques are used in combination with forced expiration technique to move the mobilized secretions to proximal airways to be cleared, which then may require subsequent cough. 2 Respiratory therapists and physiotherapists use a spectrum of airway clearance maneuvers such as active-cycle-of-breathing technique with or without gravity-assisted drainage and manual techniques as well as positive pressure devices with or without oscillations. 1Īirway clearance techniques are integral to the management of bronchiectasis, clearing conducting airways, improving pulmonary ventilation, and reducing cough and breathlessness. Impaired clearance of this mucus predisposes to mucus retention and recurrent respiratory infections. The mucus becomes colonized by bacteria and then hyperviscous and purulent. 1 In the affected areas, there is excess production of mucus due to glandular hyperplasia. Bronchiectasis is associated with damaged ciliated epithelium and compromised mucociliary clearance. Conclusion: It can be concluded that Lung Flute device and Flutter device have comparable efficacies in regards to sputum clearance in bronchiectasis with patient preference to Flutter device for the comfort of use and for ease of removal of secretions.Bronchiectasis is a lung disease characterized by repeated cycles of airway infection and inflammation that ultimately result in airway and lung parenchyma destruction. On Likert scale analysis, it was observed that significant difference was noted on "level of comfort to use the device" and "ease of removal of secretions" with Flutter device being better than Lung Flute device. ![]() Between the two devices, there was no statistical (p=0.369) or clinical (r=0.09) significant change on sputum volume. Results: Lung Flute device and Flutter device showed statistically significant increase in expectorated sputum volume with p values 0.001 and 0.000 respectively. Post treatment 24 hour sputum volume was measured and the subjects were crossed over after a 24 hour washout period. They were randomized into Lung Flute group and Flutter group wherein each group were administered 3 sessions/day. A pre-treatment 24 hour sputum volume was measured. ![]() Methods: 46 subjects diagnosed with bronchiectasis with sputum volume >30ml were selected according to inclusion criteria. Hence, a study was undertaken to compare the effect of Lung Flute device over Flutter device in mucous clearance and establish patient preference in bronchiectasis patients. There are no studies to our knowledge that have compared Lung Flute device with Flutter device. In recent years, there is a development of large number of devices to assist airway clearance and allow self-administration therapy. Purpose: The main clinical manifestation of bronchiectasis is productive cough. ![]()
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