Various devices can be used to increase the efficacy of physiotherapy and can also help with compliance if there is reluctance to do it. Oscillatory and positive expiratory pressure (PEP) devices such as the Pari PEP or Astra PEP help mobilise and move secretions. This positive pressure on breathing out helps to ‘splint’ the airways open, enabling more air to get in and out of the lungs, therefore increasing the efficiency of mucus clearance.
The Acapella Choice and Flutter are oscillatory PEP devices which provide both resistance and vibration as you exhale. It may be necessary to hold the cheeks to make sure that the vibration is in the lungs and not the cheeks. An Acapella can be used in the postural drainage position or the seated position. The Flutter is easiest used in a seated position.
These vibrations affect all the branches of the airways, and like “shaking apples from the branches of a tree”, the mucus is loosened. Whilst this is happening, the changes in air pressure that makes the steel ball move are both keeping small airways open and allowing air to move throughout the lungs. As a result of this movement, mucus is moved out from where it was previously stuck, into the larger airways and to where it can be coughed out. The Acapella has a similar effect but uses a seesaw mechanism to cause the vibration instead of a ball.
PEP devices (positive expiratory pressure) help keep the airways open by blowing against resistance. It therefore makes it easier to cough up the mucus. Ask your physiotherapist if you can try any adjuncts. Please note it is important that a physiotherapist assesses which device or technique may be most appropriate for you and teaches you how to use it.