Abstract

The flutter is a simple hand held device designed to facilitate the mobilisation of excess bronchial secretions by means of oscillating positive pressure. Traditionally patients at the Johannesburg Hospital Cystic Fibrosis clinic used the active cycle of breathing technique as a means of facilitating secretion mobilisation and clearance. When the flutter became available in South Africa in 1999 many cystic fibrosis patients wanted to change to this technique. Minimal research has been conducted comparing these two techniques. The aim of this pilot study was therefore to determine which technique is more effective in the mobilisation of secretions in cystic fibrosis patients. The pilot study was conducted on seven cystic fibrosis patients (mean age 28 years, range 16-42 years) admitted to the Johannesburg Hospital for antibiotic therapy. The study lasted four days and consisted of two treatment days separated by a washout day on which no physiotherapy was performed. Patients randomised into Group A performed the flutter technique on day two and the active cycle of breathing technique on day four. Group B performed the active cycle of breathing technique on day two and the flutter on day four. The techniques were performed twice a day for 15 minutes. The measurements taken were daily 24-hour sputum samples and daily lung function tests. A questionnaire to determine patient preference to a technique concluded the study. The results showed no statistical difference between the two techniques with regard to sputum weight or lung function (p<0.05). The questionnaire indicated that on a whole, patients had no preference for a technique.

Highlights

  • Physiotherapy has become an integral part of cystic fibrosis management

  • The flutter and active cycle of breathing technique are only two of numerous independent physiotherapy techniques used in cystic fibrosis

  • The flutter combines the techniques of positive expiratory pressure (PEP) with high frequency oscillations

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Summary

Introduction

Physiotherapy has become an integral part of cystic fibrosis management It aims to improve ventilation and mucociliary clearance through the removal of tenacious and obstructing secretions. The flutter was developed in Switzerland in the late 1980’s (Butler 1998) and is one of the newer independent airway clearance techniques. It was not readily available in South Africa until the late 1990’s when a local company started to manufacture flutter devices at an affordable price. The flutter is a hand held, pipe shaped device Within it is housed a loosely supported steel ball, covered by a perforated cap. The patient exhales actively into the pipe, generating positive expiratory pressures of 10 - 25 cm H20. The oscillating PEP prevents airway collapse and mucus clearance is enhanced by the vibrations and intermittent airflow accelerations produced by the movement of the ball (Prasad 1998; Pryor 1999)

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