Respiratory Mechanics Effects of Flutter Valve in Bronchiectasis Patients
Condition: Bronchiectasis
MeSH terms: Bronchiectasis
Study type: Interventional

Summary: 
      Considering that respiratory physiotherapy lack scientific evidence to support its
      application in the treatment of several obstructive diseases, this investigation was designed
      to evaluate the hypothesis that Flutter Valve can improve the airway clearance of
      hypersecretive bronchiectasis patients.
    

Detailed description: 
      The application of airway clearance techniques is considered an important component in the
      treatment of bronchiectasis patients (Van der Shans, 1997). For this purpose, a number of
      techniques has been introduced in the last decades. The Flutter Valve was initially proposed
      for the treatment of children with cystic fibrosis (CF) (Lindemann, 1992), but there is not
      enough evidence about its utilization in patients with bronchiectasis (Van der Shans & cols,
      1999).

      The effects of the Flutter Valve on respiratory mechanics of patients with bronchiectasis
      have been evaluated by forced spirometry (Pryor e cols, 1994; Gondor e cols, 1999; Thompson e
      cols, 2002). This approach however, does not allow the characterization of mucus
      transportation along the airways (Williams, 1994). The forced oscillation technique (FOT), a
      non-invasive alternative to characterize respiratory mechanics, allows the evaluation of
      respiratory mechanics at different frequencies without special maneuvers (Dubois e cols.,
      1956). According to eligibility criteria and in a randomized order, the patients were
      submitted to two protocols (control and Flutter Valve intervention), with one-week interval
      between them (washout). Respiratory mechanics and expectorated sputum volume were assessed
      before and after each intervention, in order to assess the Flutter Valve effect on
      tracheobronchial sputum removal.
    

Intervention name(s): Flutter Valve
Intervention type(s): Device
Intervention description(s): Flutter Valve (Scandipharm, Birmingham, AL) is shaped like a pipe with a hardened plastic mouthpiece at one end, a plastic protective, perforated cover at the other end, and a high-density stainless steel ball resting in a plastic circular cone on the inside. When the patient expires, a vibratory effect is transmitted to airways by the steel ball oscillation in order to facilitate mucociliary clearance.
In our study, the use of the equipment was guided by a registered physical therapist, but the position (angle) was determined by the patient, according to his/her adaptation and perception of effectiveness of sputum clearance. The patients remained comfortably seated, breathing through the device for 15 minutes, starting from the total pulmonary capacity, and being free to cough. Thereafter, a 5-minute session of cough was done.
Other intervention name(s): FLUTTER® Mucus Clearance Device
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: bronchiectasis; physiotherapy; flutter valve; impulse oscillation technique