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Flutter device4/25/2023 1, 2, 4 Comparisons have been made between sputum produced from individual physiotherapy sessions rather than total daily production over several days. Most studies are short with physiotherapist supervision in hospitalised patients. 1 Two studies compared the Flutter with percussion, vibration, and postural drainage by a physiotherapist in children with CF admitted to hospital with an acute exacerbation and found no significant differences in lung function or exercise tolerance. 3 In contrast, again in patients with stable CF, Pryor et al found that significantly more sputum was produced with the active cycle of breathing technique (ACBT) than with the Flutter in individual supervised sessions, but similar sputum weights were produced with both methods over 24 hours. 13 Konstan et al reported that up to three times more sputum was produced with the Flutter than with postural drainage in similar subjects. No differences were found in sputum weight or lung function after a single session with either method at the end of the treatment period, but sputum viscoelasticity was significantly reduced with the Flutter. A randomised crossover study of patients with stable CF compared 4 weeks of treatment with the Flutter with autogenic drainage. The current literature on the efficacy of the Flutter is limited and studies of its use in bronchiectasis have been in patients with CF. 10 It is not available on prescription in the UK and costs approximately £45.00. The oscillating positive expiratory pressure is reported to prevent premature closure of the bronchi, to loosen secretions, and allows mobilisation of sputum which may be cleared by the forced expiratory technique (FET). The Flutter is a simple hand held pipe-like device (fig 1) which produces an oscillating pressure wave through the repeated displacement of a steel ball within a cone. Interest has been generated in the Flutter device (Varioraw SARL, Scandipharm Inc, Birmingham, Alabama, USA), an alternative to more conventional techniques, which has been tried in a number of respiratory diseases with chronic sputum production including cystic fibrosis (CF), 1– 6 chronic obstructive pulmonary disease (COPD), 7– 9 asthma, 10, 11 and diffuse panbronchiolitis. A questionnaire indicated subjectively that patients preferred the Flutter (11/17) to ACBT for routine use.Ĭonclusions: Daily use of the Flutter device in the home is as effective as ACBT in patients with non-cystic fibrosis bronchiectasis and has a high level of patient acceptability.Īirway clearance techniques such as chest physiotherapy remain an important part of treatment in bronchiectasis, together with prompt antibiotic treatment for infective exacerbations. There was no significant change in peak expiratory flow rate or in breathlessness (Borg score) after individual physiotherapy sessions with either technique. Health status (Chronic Respiratory Disease Questionnaire) and ventilatory function did not change significantly during either treatment period. Median weekly sputum weights were similar with a median treatment difference of 7.64 g (p=0.77) and there was no evidence of treatment order or order interaction effects (p=0.70). Results: No significant differences between the two techniques were found. ![]() ![]() Methods: A randomised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home, in which 4 weeks of daily active cycle of breathing technique (ACBT) were compared with 4 weeks of daily physiotherapy with the Flutter device. The use of the Flutter, a hand held pipe-like device causing oscillating positive expiratory pressure within the airways, has been proposed as an alternative to more conventional airway clearance techniques. AUTHOR:e-mail address please Background: Airway clearance techniques are an important part of the routine care of patients with bronchiectasis.
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