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Cardinal health flutter valve11/17/2023 The exercises were performed in a sitting position subjects were instructed to perform long breathing during the treatment. The flutter equipment was used without modifications in the flutter group, whereas the control group used the flutter device without the stainless steel ball inside. Before the beginning of the study, subjects were randomized into the flutter group or the control group. Initially, patients with the diagnosis of non-cystic fibrosis bronchiectasis confirmed by computed tomography scanning were evaluated, and those who agreed to participate in the study were randomized through the draw for 2 groups: the control group or the flutter group. Thus, the aim of the study was to evaluate the effects of the flutter device on the inflammatory and microbiological mucus profile, as well as transport rates of respiratory secretions, in subjects with non-cystic fibrosis bronchiectasis. It has been speculated that this increase in the displacement by coughing and a reduction in the contact angle could be attributed to thixotropic flow, 16, 17 and this effect had been demonstrated by App et al 17 and Ramos et al 14 in subjects with bronchiectasis and cystic fibrosis, respectively.īecause hypersecretion and/or mucus stasis contributes to the perpetuation of the inflammatory process, 3, 18 we hypothesized that favoring the removal of secretions with the flutter valve technique, which is capable of increasing the volume of sputum, could also modify the inflammatory and microbiological profile of respiratory secretions. ![]() Tambascio et al 12 demonstrated an improvement in respiratory secretion transport after exercises with Flutter VRP1 in subjects with bronchiectasis. In subjects with bronchiectasis, previous research has studied the effectiveness of the flutter in relation to expectorated secretion volume, 13 mucociliary transport by the frog palate method, displacement in the simulated cough machine, contact angle, and respiratory secretion viscosity. ![]() This change in the mucus properties may result in different macroscopic aspects and transport by ciliary system or air flow. However, the main benefit of the flutter is attributed to high-frequency oscillation, possibly because of the thixotropic effect, a property of mucus that results in reduced viscosity when submitted to oscillation. Positive expiratory pressure assists in the removal of secretions by increasing alveolar pressure as a result of expiration against resistance, favoring inflation of collapsed alveoli by collateral ventilation and increased expiratory flow. 11 The flutter valve is a physical therapy alternative device for these patients because it combines 2 important secretion removal techniques: positive expiratory pressure and high-frequency oscillation. Therefore, they may benefit from physiotherapy and its various techniques. In addition to pharmacologic and/or surgical treatment, respiratory therapy is also indicated for patients with bronchiectasis, because patients have difficulty in the transport and elimination of mucus. 2, 4, 7– 9 Thus, mucus hypersecretion in patients with bronchiectasis is a permanent situation, with periods of exacerbation, which are associated with increased secretion produced. Additionally, there is hypertrophy of mucus secretory cells and alteration of the composition of the respiratory mucus, which further impairs its clearance. 4– 6 Destruction of the epithelium causes decreased mucociliary transport, which is the primary defense mechanism of the lower airways. 1– 3 Initially, this dilation is related to a destructive process on bronchial walls, caused mainly by bacterial infection and continuous inflammation this results in the destruction of the epithelial lining and of the muscular and elastic components of the bronchial walls. Bronchiectasis is a condition that is pathologically characterized by the abnormal and permanent dilation of one or more bronchi with chronic cough, expectoration of purulent sputum, and dyspnea as the main symptoms.
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