Can A Flutter Valve Help Me?
Flutter Valve Can Help Clear Airway Mucus Plugs
Dear Dr. Mahler:
I am 66 years old and read your recent blog on the presence of mucus plugs in airways on CT scanning. About one month ago I had a low dose CT scan to screen for lung cancer. The nurse called and said that there was no evidence of lung cancer.
However, I signed on to the patient portal and the report stated that I had several mucus plugs in both lower lobes. I was upset that I was not told of this and had to find out myself.
My last breathing tests were nine months ago and I was told that the Trelegy inhaler was keeping my COPD stable. I am writing to ask you what should I do now to get rid of these plugs. Last winter I had two different times that my breathing got worse. On one occasion, I went to urgent care and was treated with an antibiotic and prednisone. About 6 weeks later, I got real sick, went to the ED, and was admitted to the hospital with pneumonia.
I understand from your blog that mucus plugs increase the risk for flare-ups as I have experienced. What can I do? I read about a flutter valve on the internet. Can a flutter valve help me?
Kim from Lake Placid, NY
Dear Kim:
I am sorry to hear about your health problems last winter. It is great that you are proactive trying to prevent any future flare-ups.
Here are some recommendations that I provide for my patients with airway mucus plugs that may be helpful for you. Certainly, you need to talk with your health care professional about what is appropriate for you. In addition, you may wish to ask your primary care professional about a referral to a pulmonary physician if you do not already see a specialist.
Strategies To Help Clear Airway Mucus Plugs
Use albuterol solution in a nebulizer to first open your breathing tubes (airways). Take albuterol either 2+ hours before or 2+ hours after using Trelegy. Your health care professional will need to order both a nebulizer and albuterol solution if you do not have these.
About 10 to 15 minutes later, use saline (salt water) at a high concentration (3 to 7%) to thin the mucus. Note that saline can be irritating to your breathing tubes and might cause coughing and/or wheezing. Your health care professional will need to order the hypertonic saline.
About 10 to 15 minutes later, use the flutter valve as described below. Two different flutter valves are shown - the Acapella and the Aerobika.
Acapella flutter valve.
Aerobika flutter valve
How Do Flutter Valves Work?
These are devices that can help clear excess secretions (mucus) from the lungs. The device provides positive expiratory pressure (PEP) which involves exhaling against a resistance. During exhalation, the flutter valve has high frequency oscillations which produce vibrations within the walls of the airways to move mucus into the airway opening. The flutter valve also promotes the movement of secretions from the smaller airways into the larger (bronchi) breathing tubes. Once secretions move into the bronchial openings, the person can cough them out.
YouTube link to video How to Use Acapella flutter valve
YouTube link to video How to Use Aerobika flutter valve
Instruction For Using A Flutter Valve
Seal you lips around the mouthpiece. Then breathe in and hold your breath for about 2 seconds.
Breathe out more strongly than usual, but not hard enough to get dizzy. The device should vibrate slightly and make a fluttering noise while you breathe out. Keep breathing out until you no longer hear a flutter.
Repeat steps 1 and 2 about 8 to 10 times.
Take the mouthpiece out of your mouth and huff cough 2 to 3 times. To huff cough, breathe in a little deeper than normal, use you abdominal muscles to forcefully breathe out.
Then, give one big cough to bring mucus up and out of airways.
Follow instructions for cleaning the flutter valve.
Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.
Sincerely,
Donald A. Mahler, M.D.