CP

• flutter and acapella
• - the flutter is mechanical device that applies a variable resistance to expiratory airflow
• - the oscillation is angle dependent adjusted to create the highest frequency for the individual 8-26Hz
• - this causes an oscillation of the air within the airways, intermittent acceleration of expiratory pressure

• - oscillation of the airwaydiameter and airflow:
•  - approximates the 'pulmonary resonance' or cilia 'beat' frequency of 8-16Hz, to maximize vibration of the bronchial walls.
•  - improves gas-liquid interaction
•  - may reduce sputum viscosity by mechanically rupturing the rigid mucus gel, rearranging crosslink and reducing molecular size

• -device held at best angle for oscillations
• - breathe in slightly deeper than normal, brief hold
• - expire through device
• - 5-10 breaths out through flutter then a forced expiration through the flutter
• - continue as appropriate - 15 min?

- similar to flutter but allows a variable resistance and can be used at any angle

• -developed in germany
• - uses breathing exercises at different lung volumes to enhance expiratory airflow and therefor secretion movement
• - 3 phases unstick, collect, evacuate
• - aims to achieve maximum expiratory flow without airway collapse

• - secretion clearance
• - unstable airways

-none

• - not many people know how to perform this technique effectively
• - difficult to learn
• - difficult to teach
• -takes times to learn
• - hard to breathe at low lung volumes

• - used to aid secretion clearance
• - usually 9% saline
• - shown to increase clearance in CF, chronic bronchitis
• - main issue- may cause bronchoconstricion
• - mark elkins

• - mostly are effective
• need to consider:
• - specific pathology
• - pt preference
• - ability to perform technique
• - outcomes