Flutter mucus clearance device

Flutter mucus clearance device is designed for patients suffering from various lung disorders, associated with production and secretion of excessive quantities of mucus within the airways. By providing positive expiratory pressure (PEP), the device stimulates the transport of mucus from the lower to the upper respiratory tract and its elimination with cough. In addition Flutter is an alternative to the traditional respiratory physiotherapy.

What is mucus?

Mucus is a fluid, constantly produced by glands situated in the nose, trachea, bronchi and bronchioles. Its aim is to protect the airways by trapping various foreign agents such as small dust particles and pollutants. Antibodies and enzymes, found within the mucus, protect the underlying tissues in case of bacterial or viral invasion. In addition mucus also contains a lot of water, which humidifies the inspired air and protects the airways from dehydration.

When is mucus overproduced?

Mucus is normally present within the respiratory tract. Daily mucus secretion is around two liters and in fact its absence is associated malfunctioning of the airways. On the other side, excessive mucus secretion is a protective response in case of irritation of the airways, which tends to eliminate the irritating cause. Mucus is than being eliminated under the form of sputum. Numerous agents are able to induce hypersecretion of mucus, including banal viral or bacterial infections, smoking and allergens. Many chronic lung disorders such as asthma and COPD are also accompanied by abnormal mucus production.

What is Flutter mucus clearance device?

While in general mucus hyperproduction has beneficial effects as it helps the clearance of the respiratory tract, in some disorders the mucus is extremely thick and its evacuation is very difficult. The retained secret disturbs the normal breathing as it obstructs the airways. Moreover, it is perfect milieu for microbial growth. In these cases, in order to alleviate the breathing and avoid the risks of secondary infections, patients may be prescribed Flutter mucus clearance device. These are usually patients with chronic lung conditions. Otherwise healthy individuals are able to eliminate the excessive mucus by themselves in case of for example banal respiratory tract infection. The increased quantity of mucus in that case is due to temporary hypersecretion of the glands in the respiratory tract. On the other hand, chronic lung conditions are usually associated not only with increased glandular secretion but with the formation of new glands that also tend to have abnormal mucus secretion.

When is Flutter mucus clearance device useful?

Indications for Flutter mucus clearance device include chronic respiratory system conditions characterized by overproduction of mucus such as:

• Chronic bronchitis – a condition characterized by chronic inflammation of the bronchi accompanied by excessive mucus production, mostly due to smoking and air pollution, which, if left untreated, leads to permanent airway damage.
• Asthma – a disorder related to episodic and temporary airway obstruction due to hyperreactivity of the bronchial system towards allergens, viruses, cold, drugs and many more.
• COPD (chronic obstructive pulmonary disease) – mostly due to tobacco smoking, COPD is characterized by progressive and permanent airway obstruction, accompanied by chronic inflammation.
• Bronchiectasis – represent dilatation of one or more bronchi. The damaged bronchi tend to fill in with mucus, hard to be evacuated. In addition they often get infected and cause episodes of cough, expectoration, fever and fatigue.
• Atelectasis – collapse of part of the alveoli within the lungs which excludes them from the ventilation. Many reasons such as foreign body, tumors and abdominal surgery could lead to atelectasis.
• Cystic fibrosis – an autosomal-recessive genetic disorder associated with hyper production of thick mucus within the respiratory and gastrointestinal tracts.

Clinical researches show that elimination of mucus in patients using Flutter is increased by more than 400% compared to postural drainage elimination technique.

Mechanism of action

Flutter mucus clearance device has a form of pipe that contains stainless steel ball within. The device acts by exercising positive expiratory pressure (PEP), which means, that it acts during the expiration. The exhalation through the device makes the ball move up and down, which leads to cyclic oscillation of the airways. Its construction ensures three main effects:

1. Vibrations within the airways
2. Increased speed of exhalation of the air
3. Intermittently increased endobronchial pressure

The vibrations produced by the device loosen the thick mucus stuck on the respiratory system walls and facilitate its elimination. In addition the accelerated expiration flow aids the movement of the secret towards the upper respiratory tract. The increased endobronchial pressure keeps the alveoli opened and improves the gas exchange as alveoli tend to stick in the presence of mucus. The net result is stimulation of the cough reflex and improved elimination of the mucus.

How to use Flutter?

Patients should be carefully instructed how to use Flutter device, when prescribed one, as the correct technique is crucial for the final results. The algorithm to follow is described below.

1. The patient should sit with back straight and head slightly tilted in upward direction. In that way the airways are maximally open, the air can freely run through them and the results are optimal. Hands may be put near the body or on a table with appropriate height.
2. Initially the Flutter should be hold in a way that the stem is horizontal to the floor. The patient should breathe normally and be able to feel the vibrations produced within his/hers chest.
3. The device must then slowly be moved up and down in order to establish the position in which the vibrations felt within the chest are strongest. As the vibrations produced are one of the main factors leading to airways clearance, it is crucial to find their maximal level.
4. After the device is set in the correct position, the patient should hold it with mouth firmly closed around it and start to breathe. Several rules are to be observed in this period in order to assure the proper functioning of the device:
   – Inspiration should be slow and the patient must reach around 3/4 of its full breath
   – The breath must be hold for 2-3 seconds so the inhaled air spreads evenly within the lungs
   – Expiration should be performed to a slightly further level than normal
   – Eventual cough appeal should be suppressed
   The mucus loosens and starts to move upwards with every breath. The patient should perform 5 to 10 breathing cycles, respecting the rules above. The exhaled air should only pass through the device and not through the mouth or nose of the patient. During this period the patient should not cough, even if he needs to, as the mucus still cannot be evacuated.
5. After 5 to 10 slow breaths, the patient is than instructed to breathe 1-2 times as deeply as possible, holding its breath for 2-3 seconds and to exhale forcefully as fully as possible. In that way the mucus is transported to an upper level in the tracheobronchial system, from which it may be eliminated. This is the moment when the patient needs to cough or “huff” to facilitate the expectoration.

If the procedure is done correctly, 1 or 2 forced expirations, preceded by 5 to 10 slow inhales and exhales, should be enough to eliminate the excessive mucus. If the secret is still not evacuated, the number of slow breathing cycles should be increased. The necessary number of repetitions is individual for every patient.

The patient should be at comfort during the sessions. That’s why extended clearance sessions should be avoided. Instead the number of clearance sessions may be increased by 1.

And for how long?

As the aim of Flutter device is to help evacuate as much mucus as possible, the frequency and duration of use should be determined by a healthcare professional. In general 1 or 2 sessions a day should be enough. Each one of them continues 5 to 15 minutes. Longer procedures are not recommended. If the patient gets too tired during sessions, their number should be increased in exchange for their duration, which must be reduced. Usually, sessions are performed one in the morning and one in the evening.

How to take care of Flutter?

The Flutter device is individual and should not be used or lent to other family members. The device must be cleaned after each session. In order to do this, the device must be disassembled, rinsed with tap water, wiped and reassembled. Once in two days the device must be pulled apart, soaked into soapy water for 10 minutes, rinsed, dried and put back together. Flutter must always be stored in a cool and dry place.

Contraindications

The use of Flutter device is safe. No side-effects have been observed. The contraindications are currently only limited to patients with pneumothorax or right sided or total heart failure. Except for those patients, Flutter could be used in any mucus producing lung condition, even in children.

Advantages

• Small and portable– Flutter is lightweight and could easily be taken with at work, during vacations, trips, etc.
• Reasonable price– Flutter device is relatively cheap, designed for multiple time use and does not require additional expenses related to its support.
• Clinically proven results– Flutter device has been clinically tested and proven to be effective for mucus elimination in patients with chronic lung disorders associated with excessive mucus production.
• Easy to use– after being properly instructed the patient could use Flutter on its own without assistance from family, friends, etc.
• Does not require the assistance of a healthcare provider – Although Flutter could be used in hospitals in patients with indications, it does not require a hospital stay.
• Could improve results from bronchodilation therapy– When combined with bronchodilators delivered through nebulizer or MDI spacer, Flutter increases its efficacy. When the bronchi are filled with secrets, it’s harder for the drugs to reach them. That is why it is reasonable to combine Flutter with bronchodilators.
• Alternative to chest physiotherapy– as it has the same net effects on airways as the conventional physiotherapy.
• Economic benefits– the usage of Flutter by hospitalized patient reduces the expenses for physiotherapy and therefore decreases health care cost.
• No side effects– Flutter is not a medicament so interactions with other drugs in comorbid patients are impossible, which makes it even more useful in such patients.
• Universal– could be used by children and adults, at home or in hospitals.

Disadvantages

• Prescribed only by a healthcare professional. However, it is doubtful whether this is advantage or disadvantage, as the patient need to be instructed on how to use the device. This cannot be done in the pharmacy or the supermarket.
• Education needed- in order to obtain satisfying results, the patient should strictly follow the instructions given by his doctor. If the patient is not well instructed the use of Flutter could lead to breathing fatigue and shortness of breath. This must be avoided at any price as this is not the aim of the device. That’s why doctors should observe for the right execution of the clearance procedure. However, misusage is possible in kids or elderly persons with dementia. Such patients may need additional surveillance by family members to assure the proper usage of the device.
• Patients with severe airway obstruction may fail to breathe correctly and create sufficient airflow, compromising in that way the effectiveness of the device.

Conclusion

The growing number of patients with chronic respiratory disorders, mostly due to smoking, air pollution and hyper reactivity of the respiratory system towards different allergens, underlines the need of effective, low-cost and easy to use devices, aimed to alleviate such conditions. Flutter mucus clearance device combines all these characteristics. Its role not only in the control of the disease symptoms, but also in the improvement of the quality of life, is undoubted. Its numerous advantages have been clinically proven. The lack of side effects and relatively small number of contraindications, make Flutter’s role in the management of chronic lung diseases even more important.