• Ada Clarice Gastaldi, Paolo Paredi, Anjana Talwar, Sally Meah, Peter J Barnes, and Omar S Usmani.
• From the Physiotherapy Course, School of Medicine of Ribeirão Preto, São Paulo University, Brazil (ACG); Airway Disease Section, National Heart and Lung Institute, Imperial College London& Royal Brompton Hospital, United Kingdom (PP, SM, PJB, OSU); and Department of Physiology, All India Institute of Medical Sciences, India (AT).
• Medicine (Baltimore). 2015 Oct 1; 94 (42): e1845.

AbstractThis study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).Randomized crossover study: 15 COPD outpatients from Asthma Lab-Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures.Thirty minutes of flutter exercises: a "flutter-sham" procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed.Respiratory system resistance (R): in COPD patients an increase in X5insp (-0.21 to -0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. Following 20 min of rest, a decrease in the R5, ΔR5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size; there were no changes in FeNO levels or spirometry.The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.

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