Original Editor - Shreya Pavaskar

Top Contributors - Shreya Pavaskar and Rochelle Dsouza  

Introduction[edit | edit source]

The Flutter is a handheld device designed to facilitate clearance of mucus in hypersecretory lung disorders. Exhalation through the Flutter results in oscillations of expiratory pressure and airflow, which vibrate the airway walls (loosening mucus), decrease the collapsibility of the airways, and accelerate airflow, facilitating movement of mucus up the airways.[1]


Mechanism[edit | edit source]

  • The Flutter device consists of a hardened plastic mouthpiece at one end, a plastic perforated cover at the other end, and a valve on the inside created by a high-density stainless steel ball resting in a plastic circular cone (Fig. 1).
  • When a subject exhales through the mouthpiece, the ball rolls and moves up and down, creating an opening and closing cycle that repeats itself many times throughout each exhalation.
  • The actual position of the ball during exhalation is the result of an equilibrium between the pressure of the exhaled air, the force of gravity on the ball, and the angle of contact of the ball on the cone. The opening and closing cycles produce oscillations of endobronchial pressure and expiratory air-flow.
  • The maximum endobronchial pressure generated is approximately 20 to 25 cm H20; expiratory pressure varies between 0.8 and 2.5 cm H20 during the opening and closing cycle. Oscillations in airflow result from successive acceleration and deceleration phases that coincide with the opening and closing cycles, producing the "flutter effect."
  • The frequency of the oscillations can be modulated by changing the inclination of the Flutter device slightly up or down from its horizontal position. The patient selects the position that results in the greatest "fluttering" (i.e., vibrating) sensation within the chest. This is the position at which airway vibration is maximized.
  • Vibration of the airways presumably loosens mucus from the airway walls, acceleration of expiratory airflow facilitates the movement of mucus up the airways, and increases in endo-bronchial pressure decrease the collapsibility of the airways during exhalation, increasing the likelihood of clearing mucus from the tracheobronchial tract. This device is small, portable, and easy to use and has no side effects[3]
  • Maximum oscillation can be achieved by moving the flutter slightly up or down.
  • The Patient should keep using it until no more mucus can be expectorated.
  • Approximately 5 to 15 minutes can be taken to clear secretions.

Indications[edit | edit source]

  1. Mucus-producing respiratory conditions, including:
  2. Atelectasis
  3. Bronchitis
  4. Bronchiectasis
  5. Cystic Fibrosis
  6. Chronic Obstructive Pulmonary Disease (COPD)
  7. Asthma
  8. Other conditions producing retained secretions.

Contraindications[edit | edit source]

Patients known to have pneumothorax or overt right-sided heart failure.

Limitations[3][edit | edit source]

Gravity dependent machine

Needs to be cleaned after every session

Can be used one patient only

Requires adequate cognitive function. E.g.: Motivation and Concentration

Requires adequate motor control that means sit in correct position, hold the device at the right angle and generate adequate expiratory pressure.

References[edit | edit source]

  1. Konstan MW, Stern RC, Doershuk CF. Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. The Journal of pediatrics. 1994 May 1;124(5):689-93.
  2. Respiratory Therapy Zone. What is a Flutter Valve? (Acapella, PEP) Airway Clearance | Respiratory Therapy Zone. Available from: http://www.youtube.com/watch?v=ZfanuH-SyPA[last accessed 5/12/2021]
  3. 3.0 3.1 Rekha K, Anandh V, Doss DS, Dinesh A. Biofeedback flutter device. Biomedical and Pharmacology Journal. 2019 Jun 25;12(2):793-8.