A review investigating the flutter’s effects in people with bronchiectasis. Flutter’s effect in pulmonary function and sputum clearance in bronchiectasis
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Physiotherapist, BSc, MSc, MCSP, Larnaca, Cyprus
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Respiratory Specialist, Pulmonary Clinic Larnaca General Hospital, Larnaca, Cyprus
Marina Eleni Kloni   

4, Dikomou Street, 7550, Kiti, Larnaca, Cyprus
Pneumon 2014;27(4):307–314
Bronchiectasis is characterised by the production and retention of large volumes of secretions. These secretions could cause recurrent infections, among other complications. Chest physiotherapy aims to assist in the clearance of airway secretions and may include the flutter device. The objectives of this review are to investigate the effects of the flutter in terms of pulmonary function and sputum clearance in people with bronchiectasis.

MEDLINE, Cochrane Library, PubMed, CINAHL, PEDro and AMED databases were searched using subject-headings and keywords. The studies selected were those with a randomisedcontrolled design in which the flutter was given as one of the treatment approaches, in subjects with bronchiectasis. Inclusion and exclusion criteria were applied to the identified studies and all the relevant data was extracted and collected in a data collection sheet. The quality of these studies was assessed by two reviewers using PEDro as the quality assessment tool.

Initially, eleven studies were identified. Six studies involving 96 participants met the inclusion criteria and were reviewed. A meta-analysis was not performed due to the heterogeneity of the data in the studies. Two studies concluded in favour of the flutter in terms of sputum clearance and one study showed positive or similar results in the pulmonary function while the rest of the studies had similar or negative results when compared to control and other interventions.

Based on the sparse literature, the flutter device could be considered as a physiotherapy treatment option for bronchiectasis.

ABPA: Allergic Bronchopulmonary Aspergillosis, ACBT: Active Cycle of Breathing Techniques, AIDs: Acquired Immune Deficiency Syndrome, BC: Breathing Control, ELTGOL: Expiration with the Glottis Open in the, Lateral Posture FEV1: Forced Expiratory Volume in One Second, FEF25%-75%: Forced Expiratory Flow between 25% and 75%, FRC: Functional Residual Capacity, IC: Inspiratory Capacity, PEFR: Peak Expiratory Flow Rate, PEP: Positive Expiratory Pressure, RCTs: Randomised Controlled Trials, RV: Residual Volume, TLC: Total Lung Capacity
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