You are welcome here, anyway, but you are a rarity. It’s something we’re all familiar with unless your mutation rocks and your lungs are pristine without this much treatment. To assist with drying the tubing, it can be hung up.Let’s get some community feedback going for the masses with this topic. It is imperative that the water in the bottle is emptied and that the bottle and tubing are thoroughly cleaned after each use with warm soapy water. The performance of FET is outlined in the FET and ACBT sections. A towel can be placed under the bottle to catch any excess water.Ĭycles of breaths are followed by the forced expiration technique (FET), then coughing to further mobilise secretions. As the water may flow out of the top of the bottle during expiration, it is important to stress to patients that they must not seal off the top of the bottle as this will increase the pressure which may be a contraindication for some patients. The airflow and pressure generates bubbles within the water. The breath in should be a little more than tidal volume and, with the lips sealed around the tubing, expiration needs to be active with longer than normal expiratory flow. If this isn’t possible, they are instructed to take their lips off the tubing and breathe in through their mouth (see bottle PEP video). Sitting with the bottle resting on a table, the patient is instructed to breathe in through their nose. To check the expiratory pressure, and as a teaching tool, it is advisable to attach a manometer to the circuit, as shown in the diagram below. For this Bottle PEP set up, the oscillation frequency is 13 to 17Hz and approximate pressure between 10 to 12cmH20 is generated (Santos 2017a). Conversely, decreasing the water depth will increase oscillations and decrease the pressure during expiration. Increasing the water depth will increase the pressure and decrease oscillations during expiration. The level of PEP generated with this device is generally between 10 and 20cmH2O. An escape orifice of less than 8mm inner diameter significantly increases the PEP pressure (Mestriner et al 2009).ĭepending on the desired effect of the technique and the flow rate of the patient, the column of water is generally 10 – 13cm in depth in a bottle of at least one litre. With tubing > or = 10 mm inner diameter there are no significant PEP-pressure differences with any of the tubing lengths or flow rates, which indicates a threshold-resistor system. Tubing of > or = 10 mm inner diameter (such as suction tubing), is placed in the bottle with the bottom of the tubing resting on the base of the bottle.
The resistance with this apparatus is created by a water seal. The PEP group maintained or improved their pulmonary function whereas the Flutter group showed a significant decline and were also shown to have increased antibiotic use and hospitalisations.
Another study over a one year period, carried out with a group of children with CF compared the Flutter with PEP (McIlwaine et al 2001). In children with CF, a longer term study by Orlik et al (2001) comparing ACBT, PD with percussion +/- vibration and the Flutter found that both the ACBT and Flutter improved FEV1 and FVC values. When compared to ACBT, with or without postural drainage or autogenic drainage in people with bronchiectasis in a stable clinical state or during an acute exacerbation, Flutter® was as well tolerated and offered similar benefits in sputum expectoration as the other techniques (Eaton et al 2007, Thompson et al 2002, Tsang 2002, Herrera-Cortina 2016) and was preferred by patients (Eaton et al 2007). It was also found to reduce hyperinflation more effectively than postural drainage and slow expiration (Guimaraes 2012). Compared to no treatment, it enhanced sputum expectoration and improved quality of life in people with stable bronchiectasis (Lee 2015). In bronchiectasis, the Flutter® improved secretion transport and reduced viscosity more than mask PEP therapy (Ramos et al 2009, Tambascio et al 2011). The patient should be given written instructions including the technique, prescription and cleaning of the device.Ĭlinical application and evidence for this device During an acute infection, the frequency, the number of breaths per cycle and the number of cycles may alter. In paediatric patients, it may also depend on other factors as discussed in conjunction with the therapist and family. Depending on the daily secretion production, this type of OscPEP therapy may be applied daily, or twice daily in a stable clinical state.
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