Comparison between biofeedback Acapella and biofeedback flutter devices in COPD: A new way to improve airway clearance


  • Aneesha Dhanraj Menezes
  • K. Rekha
  • B. Sanjeev Rai



Chronic Obstructive Pulmonary Disease, COPD, Acapella, Flutter Biofeedback, forced vital capacity, Forced expiratory volume, Oxygen saturation, Sputum weight


Introduction and Aim: In recent years, biofeedback systems have been integrated into a variety of devices. Biofeedback system is the process of gaining awareness of one's physiological functions by an apparatus which provides participants feedback of their performance. Respiratory training with a biofeedback system provides the correct breathing pattern, reduces respiratory rate and tension, enhances respiratory function, improves gaseous exchange, improves ventilation and perfusion mismatch. Therefore, it reduces sympathetic nervous system activity by clearing secretions. As clearing the mucous from the airways is the initial stage of respiratory rehabilitation, this study sought to implement a biofeedback system in an Acapella and flutter device and compared the effectiveness of both the positive expiratory pressure (PEP) devices (Acapella and Flutter) with biofeedback on lung functions in chronic obstructive pulmonary disease (COPD) patients.


Materials and Methods: 30 patients were assigned randomly to the acapella group or the flutter group with 15 patients in each group. The Acapella biofeedback group used the Biofeedback Acapella device for 15-20 minutes per day for five days, while the Flutter biofeedback group used the Biofeedback Flutter device simultaneously.


Results: The biofeedback acapella group and the biofeedback flutter group showed significantly higher increases in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and oxygen saturation (SpO2). There was no significant difference between the groups. In addition, there was a significant difference in sputum weight, within both the groups reducing significant amounts of sputum and improving symptoms.


Conclusion: These results suggest that both Biofeedback Acapella device and the Biofeedback Flutter device help in improving lung function and oxygen saturation in COPD patients. Further scientific studies are needed to be performed to confirm the results and to determine the optimal durations and frequencies used in these devices. We also recommend further improvement and development of airway clearance devices.

Author Biographies

Aneesha Dhanraj Menezes

Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

Father Muller Research Centre, Mangalore, Karnataka, India

K. Rekha

Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

B. Sanjeev Rai

Father Muller Research Centre, Mangalore, Karnataka, India


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How to Cite

Dhanraj Menezes A, Rekha K, Sanjeev Rai B. Comparison between biofeedback Acapella and biofeedback flutter devices in COPD: A new way to improve airway clearance. Biomedicine [Internet]. 2023 Nov. 9 [cited 2023 Dec. 2];43(5):1568-73. Available from:



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