A Comparison of 2 Respiratory Devices for Sputum Clearance in Adults With Non-Cystic Fibrosis Bronchiectasis

BACKGROUND: Airway clearance techniques are a vital part of routine care for patients with bronchiectasis. There is no clear superior modality. The Flutter combines oscillations (6-20 Hz) and positive expiratory pressure; the Lung Flute combines positive expiratory pressure and low frequency acoustic waves (18-22 Hz), to augment clearance. This project aimed to compare these devices. METHODS: This was a randomized crossover study of adult subjects with stable non cystic fibrosis bronchiectasis (expectorating > 25 mL/d). Subjects attended 2 separate out-patient visits, 1 week apart, and completed a supervised sputum clearance regime and Lickert scale (8 questions regarding subjects' perception of the experience using each device). Total sputum expectorated during supervised intervention (T1) and after 30 min from the end of T1 (T2) was recorded as wet sputum weight. Total wet sputum weight desiccated in a microwave (10 min at 300 watts), allowed measurement of total dry sputum weight. Data were compared using paired t test. RESULTS: We recruited 40 subjects with a mean +/- SD age of 63 +/- 16 y. Overall, there was no significant difference in wet sputum weight (Flutter, 5.78 +/- 6.47 g; Lung Flute, 5.75 +/- 0.22 g) and dry sputum weight (Flutter, 0.40 +/- 0.86 g; Lung Flute, 0.22 +/- 0.21 g). At T1, wet sputum weight was higher for the Flutter (5.10 +/- 6.26 g) compared with the Lung Flute (3.74 +/- 3.44 g) (P = .038). At T2, wet sputum weight was higher for the Lung Flute (2.02 +/- 3.01 g) compared with the Flutter (0.68 +/- 0.75 g) (P = .001). Subjects perceived the Flutter as being significantly better at clearing secretions (P = .01), easy to understand (P = .03), and simple to use (P = .01) compared with the Lung Flute. CONCLUSIONS: Both devices were well-tolerated and successfully augmented secretion clearance. Most subjects preferred the Flutter because of increased speed of secretion clearance, and greater ease of use.