What Are Flutter Valves and Acapellas? 

I have been getting lots of questions lately about flutter valves and acapellas. A common one that has been advertising heavily is a brand called AirPhysio. I am asked, “What do you think of this new thing they are advertising all over Facebook?” So, here is my humble response.

What are flutter valves?

First of all, they are not really new devices. They have been used in hospitals for years. They have also been available for people with lung diseases for years. People most familiar with them may include patients with cystic fibrosis, bronchiectasis, and COPD. Although, some people with asthma also may benefit from them.

PEP and oscillating vibrations

The devices are helpful because they offer both PEP and oscillating vibrations.

PEP

This is positive expiratory pressure. When you exhale into the device, you exhale against resistance. This creates a positive pressure of 5-10 CWP. The positive pressure holds airways open while you are exhaling. This helps push secretions into your airways, making it easier to cough up secretions.¹

Oscillating vibrations

When you exhale, a ball in the device oscillates fast enough to create vibrations. These vibrations reverberate to your airways, causing you to feel vibrations inside your chest. The idea is this will knock stubborn secretions off airway walls. This makes it easier to cough up secretions.¹

Secretion clerance

The combination of PEP and vibrations makes your cough more effective. Flutter valves are nice in that they are small handheld devices. They usually look like a small pipe and are portable. They can be used anytime and any place by the patient. Studies do show that they are effective at helping patients with secretion clearance.^1-2

Resistance and gravity

You can also increase or decrease the resistance. Many models allow you to increase the resistance by tilting the device up slightly. Doing the opposite will decrease the resistance. Some newer models allow you to turn a knob to increase and decrease resistance. A problem with flutter devices is they rely on gravity to work. So, it is essential that they remain level with the ground. This makes sitting or standing an ideal position when using them.

What are acapella devices?

Acapella devices are similar to flutter valves in that they create PEP and vibrations when you exhale into them. However, rather than being shaped like a pipe, they are shaped like a cone. Plus, they are not gravity-dependent. For this reason, they can be used in pretty much any position.¹

There are different types of acapella devices but the ones that I am familiar with are blue and green.^1-2

Blue acapellas

These are for people who cannot generate a high flow (flows less than 15 LPM). So this makes them ideal for those with severe airflow limitation, or people with severe COPD.

Green acapellas

These are for people who can generate a high flow (flows greater than 15 LPM). This makes them ideal for people with mild or moderate COPD.

Other devices

There are also other types of acapellas and they are all similar in design. You blow into them and feel vibrations in your chest. This is meant to knock secretions loose so you can more easily cough them up. They also can be easily taken apart and cleaned.

How do you use these devices?

Regardless of the device, the mode of use is similar. I will give these instructions as I’d teach them where I work.

1. Hold the device in your hand.
2. Stand or sit up tall (this is the ideal position).
3. For the flutter valve, the base must be level with the ground. For the acapella, this is ideal, although not essential.
4. Take in as deep a breath as you can.
5. Place your mouth on the mouthpiece.
6. Close your lips around the mouthpiece.
7. Exhale into the device. You should feel vibrations in your chest.
8. Repeat these steps up to 10 times without coughing. This is because each exhalation into the device helps to loosen secretions and move them up your airway.
9. Attempt a cough to help bring up secretion. If your cough is nonproductive, steps 1-8 can be repeated up to 3 times (or more if you are so inclined).
10. This should be done 2-4 times during the course of a day. If you take breathing treatments, the best time to use these devices is after your treatment. This can also be done as needed when you feel like you need to cough but can't seem to bring anything up.

Availability and observation

Where can you get one?

Where I work, we give acapella devices to anyone with COPD. I do know that one of our neighboring hospitals uses flutter devices. Either way, these devices are great for assisting with secretion clearance. Ultimately, the goal is to help reduce the risk for respiratory infections. These devices are single patient use, so we allow and encourage patients to take them home and use them as instructed.

In the past, I think these devices were only available in the clinical setting. Although, after doing a google search, I see that they are available at online stores. So, if you are interested in using one, you can talk to your physician. Or, you can do a Google search. I think the maximum price I saw was $30 for an Acapella.

Good results in patients

I personally really like these devices. I have seen good results and patients seem to really like them too. While the goal is to improve sputum clearance, they have also been shown to have other benefits, such as improving lung function.³