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  • Handheld oscillatory positive expiratory pressure units consisting of a pipe-like device that includes a steel ball in the inner cone (i.e., the pipe bowl) that is loosely covered by a perforated cap. The weight of the ball provides positive airway pressure (close to 10cm of H20) during expiration (i.e., positive expiratory pressure, PEP), and the ball movement on/off the bowl generates oscillations with a changing frequency ranging from 2 to 30 Hz (typically about 15 Hz) according to the device position. Flutter valve devices are intended to shear mucus from the airway wall by oscillatory forces, prevention of early airway closure by stabilization of the airways with PEP, changes in mucus rheology, and to aid in mucus mobilization and expectoration. They are intended mainly for use in patients with chronic obstructive pulmonary diseases.
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