Background[edit | edit source]
An ineffective cough or an impairment of normal mechanisms of mucociliary clearance limits oxygen transport from the lungs to body tissues. A variety of techniques are available for assisting the mobilization of airway secretions to augment a patient’s mucus mobilization and expectoration. The caregiver must take into consideration the pathophysiology and the clinical manifestations of the disease, availability of the technique to the patient, and the patient’s acceptance of the technique when prescribing an optimal method of airway clearance.
Introduction[edit | edit source]
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[edit | edit source]
- Removable mouthpiece
- Body of the device
- Expiratory resistance dial, which allows the patient to adjust the difficulty of breathing into the device
- One-way inspiratory valve
How to use[edit | edit source]
When using the Acapella for the first time, make sure the frequency adjustment dial is set counterclockwise to the lowest frequency-resistance setting.
- Sit on a chair in a upright posture. Keeping your back straight and elbows resting comfortably on a table. Now gently, tilt your head slightly upwards thus keeping the upper airways open.
- Take a deeper breath than normal inhalation. Making sure that your lips are wrapped around the mouthpiece, then with a forceful exhalation blow into the device.
- Ideally, you should blow out about twice as fast as normal.
- Continue this process for approximately 10 breaths.
- After the final attempt, make sure to expel to remove the secretions from the airways. Additionally, you can even perform 2 to 3 “huff” to enhance secretion removal as needed.
- Note: You must be able to exhale for at least three to four seconds while using the device. Failing to maintain your exhalation for this advised length of time, requires you to turn the adjustment dial to increase the resistance.
- This adjustment helps the patient exhale at a lower flow-rate by raising the total resistance of the vibrating orifice.
Types of Acapella[edit | edit source]
The Acapella is available in 2 models:
- Green device for patients who can sustain at least 3 seconds of expiratory flow > 15 L/min
- Blue device for patients with expiratory flow < 15 L/min.
Indications[edit | edit source]
- Mucus-producing respiratory conditions, including:
- Cystic Fibrosis
- Chronic Obstructive Pulmonary Disease (COPD)
- Respiratory Muscle Weakness
- Mechanical Ventilation
- Neonatal Respiratory Distress Syndrome
Contraindications[edit | edit source]
- Untreated pneumothorax
Advantages[edit | edit source]
The Acapella is advantageous to some patients due to 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[edit | edit source]
- Faarc, Kacmarek Robert PhD Rrt, et al. Workbook for Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020
- Volsko TA, DiFiore JM, Chatburn RL. Performance comparison of two oscillatory positive pressure devices: Acapella versus Flutter. Respiratory Care 2003; 48(2):124-30.
- Smiths Medical. Acapella | An introduction to Physiology and Vibratory PEP Therapy. Available from: https://www.youtube.com/watch?v=L5gEwEIkRjo [last accessed 31/3/2022]
- CMC Vellore. Use of Acapella for Airway Clearance for Cystic Fibrosis Patients. Available from: https://www.youtube.com/watch?v=uOscl37oHzg [last accessed 31/3/2022]
- Patterson JE, Hewitt O, Kent L, Bradbury I, Elborn JS, Bradley JM. Acapella versus 'usual airway clearance' during acute exacerbation in bronchiectasis: a randomized crossover trial. Chron Respir Dis. 2007;4(2):67-4