Are both flutter valve and nebulizer necessary?

Is there a specific brand or type of flutter valve that any of you would recommend?

Common "flutter" choices with link to manufacturers site below. Aerobika seems to be the most preferred/commonly one used. Probably because NJH started recommending it a few years ago.

It's really personal preference, trial and error. Until recently, I used aerobika during 7% saline neb. Now I don't use a flutter device at all. I neb hypertonic saline directly into lungs per Dr. McShane's recent talk. I do not miss the flutter and it's one less item to clean/sterilize. Fortunately, I can get the gunk out through autogenic drainage and ACB (active cycle of breathing.)

PARI O-Pep
https://www.pari.com/us/products/airway-clearance-devices/pari-o-pep-us/
Acapella Choice
https://www.icumed.com/products/airway-management/respiratory/bronchial-hygiene/acapella/
Aerobika
https://www.monaghanmed.com/product/aerobika-opep-device/

Most people DO need to use the flutter and are recommended to do so. In my case it is the only thing that works after 30 + minutes of saline. The Aerobika was found to be more effective in at least one study I read. I have found it way more effective than the Acapella.

Hi there Irene

I remember you saying that you had large volumes of mucus, I believe, as I do. Wondering if you have found any answers? I am still producing around 7oz each time I nebulise.

I have not found any answers yet. So far medical people seem to think it is asthma, post nasal drip etc largely, despite my having Bx, MAC, hiatus hernia, reflux.

Last physio wanted me to stop nebbing hypertonic because she thought that as aggravating everything. I tried that and didn't feel I was clearing my lungs as well, so have recommenced nebbing.

I also use the free android phone app for autogenic drainage and find that helps too after nebbing .

Best wishes.

I feel as if something is causing me to have more mucus than most people. But on the other hand Pseudo is known to cause alot of mucus. Given the color of mine and the amount and how I am doing on the whole it is probably the pseudo infection causing so much. But I do also produce in addition to the colored, alot of white foamy mucus. I have yet to hear of an explanation for the white foamy that makes much sense (from pulmos). But it does seem like those with reflux report it. I still am amazed at your volume. Mine is about 3 ounces which is a lot. 7 is so much. But it does not sound like you are getting very good explanations for it. Is it clear or colored?

I was diagnosed with bronchiectasis about a year ago and didn't consistently do airway clearance until this year when it was confirmed I have MAC/MAI. Airway clearance is one of the most important things to prevent additional infections and keep the environment as clear as possible. The more mucus that sits in your lungs, the more habitable the environment for bacteria.

Dr. Shane's lecture on Airway clearance is really helpful to watch and is super informative if you're just starting out.

One thing she also mentions is postural drainage which is simply putting your body into a position that will allow gravity to assist in draining mucus to the larger airways so it can be coughed out. I have tried doing this after I nebulize with saline. You can also try percussive cupping in the areas that helps dislodge and loosen mucus after nebulizing. I have tried using my Aerobika while in a postural drainage position and that has helped me a lot.

I'm new so can't post links in my comments yet unfortunately otherwise I would have provided links for the video lecture.

Kate

@kdiago1564, I noticed that you wished to post links to an article and a video with your post. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe.

Allow me to post them for you:

- Postural Drainage positions: https://bronchiectasis.com.au/physiotherapy/techniques/gravity-assisted-drainage
- Dr. Pamela Shane's Airway clearance video:

Clear and foamy...occasionally a spot of yellowish when I have coughed into the basin. If I could understand what was causing it I would stand a better chance of addressing it.

I had forgotten you had pseudo as well. Best wishes with it.

I showed the ID doctor what I bring up almost all day long, the foamy white bubbly or the clear bubbly. He indicated it is water/moisture. My understanding, if it is correct, is that when you nebulize the saline it is to bring moisture out into the lungs to help move the mucus. However I also understand that the with a Hiatal Hernia, which I have also, it causes overproduction of mucus. This mucus, for me, is especially heavy and constant when I eat or drink, all I drink is water. I believe, for me, it is the hiatal hernia causing lots of the mucus and it 'ain't fun. It is very tiring having to clear the throat so much, all day long, because it just keeps coming up and is so sticky that it needs to be cleared out. I don't cough it up I suck it up and out. All this white bubbly foamy I speak of does not necessarily have mucus plugs in it. There are times when I do have a mucus plug(s) come up when I have sucked up that which is in my throat. I don't always get mucus plugs with each time I do air way clearance, huff cough etc. etc. My plugs are mostly yellow, to the light yellow green. My sputum submissions have come back stating MAI. No pseudomonous showing in sputums so far. As of yet, I have not been told to start anti-biotics. My PFT is very good. So, for myself.....all I can do is what I feel is best for me knowing what the tests have shown and what we should do for....Bronchiectasis, Hiatal Hernia. I am sure we share some of the same frustrations as many of us do. Irene opened my eyes for me to give greater thought about the Hiatal Hernia and what it was possibly causing. Barbara

Thank you so much for that informative reply, Barbara. It is good to know that I am not alone...at least...and to gain understanding of what may cause it. I have also recently been diagnosed with MAI.

I was told to use surgery as a last resort for the hernia, and have heard of people who have bad results, ie not being able to vomit etc, afterwards, so am hesitating on that one. I believe mine was caused by coughing. Someone recently suggested a barium swallow, which I may proceed with.

It is great you have good PFT...mine showed a decrease of 25% recently apparently. Best wishes, Narelle