The Flutter

• The Flutter:

  • A small mechanical device that incorporates a high-density ball bearing
  • Expiratory airflow moves the ball bearing producing both positive expiratory pressure (PEP) and high frequency oscillations of air within the airways
  • done in sitting

  
• Effects of the Flutter:

  • Production of positive expiratory pressure causes an increase in end expiratory lung volume therefore reducing airway resistance and small airway closure
  • Channels of collateral ventilation are recruited allowing air to flow behind sputum plugs, facilitating secretion movement
  • High frequency oscillations create airway vibrations that mobilise excess secretions
  • Reduces sputum viscoelasticity
• Flutter Technique:

  • Usually used in sitting or supine
  • Breathe in through nose and out through the Flutter
  • Start with 4 - 8 quite deep inspirations with inspiratory hold, expiring against Flutter (mucus loosening stage)
  • Then one maximal inspiration with inspiratory hold, followed by a forced expiration through the Flutter (mucus elimination stage)
  • Follow with a huff/cough as necessary