Acapella

Background

An ineffective cough or an impairment of normal mechanisms of mucociliary clearance limits oxygen transport from the lungs to body tissues. An array of techniques for assisting the mobilization of airway secretions is available for patients and caregivers to augment a patient’s mucus mobilization and expectoration. The caregiver must consider the pathophysiology and the clinical manifestations of the disease, the physiological basis of the method, availability of the technique to the patient, and the patient’s acceptance of the technique when prescribing an optimal method of airway clearance.

Introduction

The Acapella is a Oscillatory PEP device that provides oscillation to the airways which helps loosen secretions and move them centrally. The Acapella delivers high-frequency oscillation and PEP by employing a counterweighted lever and magnet. Exhaled gas passes through a cone, which is intermittently occluded by a plug attached to the lever, producing air flow oscillations. A knob located at the distal end of the device adjusts the proximity of the magnet and counterweighted plug, thereby adjusting the frequency, amplitude, and mean pressure

Parts of the Acapella

1. Removable mouthpiece
2. Body of the device
3. Expiratory resistance dial, which allows the patient to adjust the difficulty of breathing into the device
4. One-way inspiratory valve

How to use

For someone using the Acapella for the first time, make sure the frequency adjustment dial is set counterclockwise to the lowest frequency-resistance setting.

• Sit in a chair by keeping your back straight. Keep your elbows resting comfortably on the table. Now, tilt your head slightly upward.
• This will help to keep the upper airway open wide. As a result, the air you exhale will be able to flow out smoothly.
• Take a breath that is deeper than a normal inhalation. Make sure that your lips make a tight seal around the mouthpiece, then blow into the device with a forceful exhalation.
• Typically, you should blow out about twice as fast as normal, but not as hard as you can.
• Repeat this process for approximately 10 breaths.
• After the final attempt, be sure to cough, in order to remove the secretions from the airways. You can even perform 2 to 3 “huff” coughs in order to increase secretion removal as needed.
• Note: You must be able to exhale for at least three to four seconds while using the device. If you fail to maintain your exhalation for this advised length of time, then you need to turn the adjustment dial to increase the resistance.
• This adjustment will help the patient exhale at a lower flow-rate by raising the total resistance of the vibrating orifice.

Types of Acapella

The Acapella is available in 2 models:

1. Green device for patients who can sustain at least 3 seconds of expiratory flow > 15 L/min
2. Blue device for patients with expiratory flow 15 L/min.

Indications

1. Mucus-producing respiratory conditions, including:
2. Atelectasis
3. Bronchitis
4. Bronchiectasis
5. Cystic Fibrosis
6. Chronic Obstructive Pulmonary Disease (COPD)
7. Asthma
8. Respiratory Muscle Weakness
9. Mechanical Ventilation
10. Neonatal Respiratory Distress Syndrome

Contraindications

1. Untreated pneumothorax
2. Hemoptysis
3. Intracranial pressure > 20 mmHg
4. Acute dyspnea
5. Severe nausea

Advantages

The Acapella may offer advantages to some patients by virtue of its ability to generate OPEP at any angle (eg, with the patient supine) and at very low expiratory flows (eg, in children with severe obstructive lung disease). REFERENCES