Comparison between biofeedback Acapella and biofeedback flutter devices in COPD: A new way to improve airway clearance
Keywords: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.
Paul Raj, M., Shristhudhi, S.D., Vinod, S.K., Anand Babu, K. Effectiveness of PNF of respiration to improve the exercise capacity in patients with COPD: A Pilot Study; International Journal of World Research. 2017; Corpus ID: 165154708.
Viswambhar, V., Bandlamudi, S., Shanmuganathan, A., Narasimhan, M., Ashwin, K.J., Navaneetham, K. Association between severity of disease and thoracic wall dimensions among chronic obstructive pulmonary disease patients–A cross sectional study. Biomedicine. 2020 Nov 9;40(3):386-391.
Jayson, C.J., Vaishnavi, G., Tharani, G., Kamatchi, K., Kirupa, K. To compare the effect of Acapella and diaphragmatic breathing exercise in COPD patients. International Journal of Current Research. 2018;10(01): 64611-64614.
Shaikh, S., Vishnu Vardhan, G.D., Gunjal, S., Mahajan, A., Lamuvel, M. Effect of Inspiratory Muscle training by using breather device in participants with Chronic Obstructive Pulmonary Disease (COPD). International Journal of Health Sciences & Research. 2019; 9(4):68-75.
Richa, Aggarwal, R., Abu Shaphe, M., A comparison of flutter device and active cycle of breathing techniques in acute exacerbation of chronic obstructive pulmonary disease patients; Indian Journal of Physiotherapy and Occupational Therapy. 2010; 4(3):60-64.
Downie, P.A. Cash Textbook of Chest, Heart and Vascular Disorders for Physiotherapists. 4th edition: 464-467.
Rekha, K., Vaiyapuri, A., Doss, S.S., Dinesh, A. Biofeedback Flutter Device. Biomed. & Pharmacol. J. 2019;12(2):793-798.
Sharma, P., Prem, V., Jain, S. Immediate Effects of Acapella on Dynamic Lung Compliance in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome: A Case Series. Indian J Crit Care Med. 2018;22(2):100-102.
Papadopoulou, H.A., Tsanakas, T., Diomou, G., Papadopoulou, O. Current devices of respiratory physiotherapy. Hippokratia. 2008; 12(4): 211-220.
Volsko, T.A., DiFiore, J., Chatburn, R.L. Performance comparison of two oscillating positive expiratory pressure devices. Acapella versus flutter. Respiratory Care. 2003 48: 124-130.
Hardy, K.A. A review of airway clearance: new techniques, indications and recommendations. Resp Care. 1994; 39:440.
Zhu, Q., Zheng, F., Xie, Y.Y. Respiratory training biofeedback system. International Conference on Electronics, Communications and Control (ICECC). September 9, 2011: 3915-3918.
Rekha, K., Vaiyapuri,V. Doss, S.S. A survey: effects of different biofeedback system analysis with flutter device in respiratory disorders. Biomedical Research. 2018:29(6):1222-1231.
Eric, J., Heckman, M.D., O’Connor, G.T. Pulmonary Function Tests for Diagnosing Lung Disease. JAMA,2015;313(22): 2278-2279.
Celli, B. R., Marin, J., Casanova, C. Sputum weight as a marker of disease severity and response to treatment in COPD. American Journal of Respiratory and Critical Care Medicine. 2004; 169(11): 1213-1218.
Gastaldi, A.C. Flutter device review: Effects on secretion and pulmonary function. Journal of Novel Physiotherapies. 2016; 6(3): 1-6.
Jayson, G. G., Jones, P., Mackay, I. R., Polkey, M. I. A randomized controlled trial of Acapella versus Flutter in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine. 2007;175(10):1125-1131.
Skarie, M. S., Al-Farsi, M., Al-Ani, M., Al-Naimi, F. A randomized controlled trial of the Acapella and Flutter devices in patients with chronic obstructive pulmonary disease. Respiratory Medicine. 2015;109:54-60.
Santos, A.P.D., Guimaraes, A.C., de Carvalho, E.M., Gastaldi, A.C. Mechanical behaviours of Flutter, VRP1, Shaker and Acapella Devices. Respiratory care. 2013;58(2): 298-304.
Jahan, S., Kumar, L., Ahmed, F. Comparison of effect of flutter device versus autogenic drainage on peak expiratory flow rate, oxygen saturation, respiratory rate and pulse rate in COPD patients. Journal of Novel Physiotherapy and Physical Rehabilitation. 2015; 2(4): 044-050.
Castro, R.T., Caceres, N. S., Garrido Baquedano, R. G., Problete, M. B., Yanez, M.O., Vasconcello, L. Agreement between clinical and non- clinical digital manometer for assessing maximal respiratory pressures in healthy subjects. Plos One. 2019; 14(10): 1-10.
Hardavella, G., Gaagnat, A.A., Saad, N., Rousalova, I., Katherina, B. How to give and receive feedback effectively. Srerer, Breathe (sheff). 2017; 13(4):327-333.
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