Randomised crossover study of the Flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis

Abstract

Background: Airway clearance techniques are an important part of the routine care of patients with bronchiectasis. The use of the Flutter, a hand held pipe-like device causing oscillating positive expiratory pressure within the airways, has been proposed as an alternative to more conventional airway clearance techniques. Methods: A randomised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home, in which 4 weeks of daily active cycle of breathing technique (ACBT) were compared with 4 weeks of daily physiotherapy with the Flutter device. Results: No significant differences between the two techniques were found. Median weekly sputum weights were similar with a median treatment difference of 7.64 g (p=0.77) and there was no evidence of treatment order or order interaction effects (p=0.70). Health status (Chronic Respiratory Disease Questionnaire) and ventilatory function did not change significantly during either treatment period. There was no significant change in peak expiratory flow rate or in breathlessness (Borg score) after individual physiotherapy sessions with either technique. A questionnaire indicated subjectively that patients preferred the Flutter (11/17) to ACBT for routine use. Conclusions: Daily use of the Flutter device in the home is as effective as ACBT in patients with noncystic fibrosis bronchiectasis and has a high level of patient acceptability.

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study

“…Also, the effect of physiotherapy on PFT is a matter of controversy. In studies utilizing oscillation devices and ACBT techniques, no change in PFTs have been reported [3,14,21], similar to our observations. This may be explained on the basis of the irreversible damage and bronchial dilatation despite the achievement of effective airway clearance in bronchiectasis.…”

“…Recent studies have particularly focused on the comparative efficacy of ACBT and Flutter® in patients with cystic fibrosis (CF) or bronchiectasis. In one of these studies, no difference in the amount of daily sputum production could be detected, and no clear-cut data were provided concerning whether the intervention was carried out at home or at the hospital settings [3]. Similar to our study, ACBT and an oscillation device were compared in a study that lasted 3 days, and the device was found to be as effective as ACBT in terms of sputum production [16].…”

“…Studies examining the effect of physiotherapy on the quality of life in patients with bronchiectasis are very scarce in number, and only one study, which assessed the effect of the Flutter® and ACBT on the quality of life, is reported in the literature [3].…”

“…The positive expiratory pres-DOI: 10.5152/TurkThoracJ.2018.17050 Bilge Üzmezoğlu 1 sure was shown to be more effective than Flutter® in terms of preserving pulmonary function, hospital admissions, and antibiotic use in patients, who were followed up for 1 year [5]. Daily use of the Flutter® device at home was as effective as ACBT in patients with non-CF bronchiectasis, and it leads to higher levels of adherence by patients [3]. To our knowledge, there have not been many trials on evaluating effectiveness of home-based physiotherapy program.…”

“…In this regard, the Flutter® device represents an alternative to traditional physiotherapeutic modalities and has been increasingly used in the management of respiratory conditions characterized by chronic sputum production. Flutter® is a simple handheld device that allows removal of mucus from the airways using positive expiratory pressure ( Figure 1) [3]. Active cycle of breathing techniques (ACBT) is a standard technique, and it bears some advantages.…”