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Flutter Device Review: Effects on Secretion and Pulmonary Function

Ada Clarice Gastaldi

The flutter is a respiratory device that produces an oscillatory positive expiratory pressure that can be used as an alternative for removal of secretions. The effects of flutter have been studied in patients with different diseases, using different protocols and outcomes, and its effects on secretions and pulmonary function are not well established. In this review, we present the results from studies that have used flutter as a physical therapy intervention compared with a control or sham group or compared to other physical therapy techniques. The device has demonstrated its beneficial effect on removal of secretions increasing the volume of expectoration and a decrease in the viscosity of secretions, increasing in vitro transport of secretions from cystic fibrosis and bronchiectasis patients. The effects of flutter on pulmonary function are controversial with no changes or improvement in some studies, and some possible negative effects that could be associated with the flow dependent mechanism. The airways resistance or respiratory resistance were not changed in some studies and the only one that showed a decrease in the respiratory system resistance studied patients with large amounts of secretions. In conclusion, the flutter can decrease the viscoelasticity of respiratory secretions favouring the secretions transport and elimination, which can be used for stable patients or during exacerbation. The effects in the pulmonary function / mechanics needs to be better investigated.