The effects of flutter have been studied in patients with cystic fibrosis, chronic obstructive pulmonary disease (COPD), bronchiectasis, and others, using different protocols and outcomes, in children and adult patients, and its effects on secretions and pulmonary function are not well established. The oscillations produce a thixotropic effect, which is a decrease in the viscoelasticity of secretions when subjected to a constant vibration. The PEP helps the removal of secretions by increasing the alveolar pressure due to expiration against resistance producing a positive pressure which helps hold airways open and may reducing peripheral airway resistance. This device is a combination of two different techniques: PEP and oscillations. During the expiration through the flutter, the expiratory flow causes the steel ball up and down movement, creating an oscillatory positive expiratory pressure (PEP) with a back transmission to the patient. It is a simple and small plastic device shaped like a pipe, with a mouthpiece at one end and a perforated cover at the other end and with a stainless steel ball resting in a plastic cone inside ( Figure 1). The flutter is a respiratory device that can be used as an alternative for removal of secretions proposed by Lindeman. Different physical therapy techniques can help patients patients that are not able to produce enough expiratory flow or because they have too much secretions or because their secretions are too thick. The physical therapy can contribute to prevent or treat complications arising from the retention of secretion in patients with hipersecretory chronic diseases or during exacerbations. Keywordsįlutter device Physical therapy modalities Intrathoracic oscillation Chest physical therapy Pulmonary function AbreviationsĬOPD: Chronic Obstructive Pulmonary Disease PEP: Positive Expiratory Pressure CF: Cystic Fibrosis Log G*: Mucus Impedance MCI: Mucociliary Clearance Index CCI: Cough Clearance Index PDPV: Postural Drainage, Percussion, and Vibration IPV: Intrapulmonary Percussive Ventilation ACBT: Active Cycle Breathing Technique HFCWC: High Frequency Chest Wall Compression ELTGOL: Slow Expiration With Glottis Opened in Infralateral Decubitus Position VC: Vital Capacity FEV1: Forced Expiratory Volume in 1 Second PEF: Peak Expiratory Flow FVC: Forced Vital Capacity RV: Residual Volume FEF: Forced Expiratory Flow TLC: Total Lung Capacity FET: Forced Expiration Technique HAT: Hydro Acoustic Therapy AD: Autogenic Drainage PDP: Postural Drainage And Percussion Raw: Airway Resistance R5: Respiratory System Resistance at 5 Hz X5: Respiratory System Reactance at 5 Hz Fres: Resonant Frequency Introduction The effects in the pulmonary function / mechanics needs to be better investigated. In conclusion, the flutter can decrease the viscoelasticity of respiratory secretions favouring the secretions transport and elimination, which can be used for stable patients or during exacerbation. The airways resistance or respiratory resistance were not changed in some studies and the only one that showed a decrease in the respiratory system resistance studied patients with large amounts of secretions. The effects of flutter on pulmonary function are controversial with no changes or improvement in some studies, and some possible negative effects that could be associated with the flow dependent mechanism. The device has demonstrated its beneficial effect on removal of secretions increasing the volume of expectoration and a decrease in the viscosity of secretions, increasing in vitro transport of secretions from cystic fibrosis and bronchiectasis patients. In this review, we present the results from studies that have used flutter as a physical therapy intervention compared with a control or sham group or compared to other physical therapy techniques. The effects of flutter have been studied in patients with different diseases, using different protocols and outcomes, and its effects on secretions and pulmonary function are not well established. The flutter is a respiratory device that produces an oscillatory positive expiratory pressure that can be used as an alternative for removal of secretions.
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