The Oscillatory Positive Expiratory Pressure Device (Acapella)

Don’t forget to read the basics of airway clearance techniques for full application of this tool!

What is an Acapella Device?

• Provides Positive Expiratory Pressure (PEP) to exhalation
• Used for pulmonary hygiene to increase/maintain secretion mobility, increases  sputum production
• Promotes increased lung volumes due to re-inflation of collapsed airways
• Changes focus to Exhalation instead of Inhalation!
• Improves the efficacy of inhaled medications! See this post for more information!
• Improves amount of time someone can participate in exercise and reduces the amount of time they need to recover dyspnea after exercise (see more about that here!).
  

Patients who can benefit from Acapella use:

COPD                                     
Bronchiectasis
Pneumonia (viral or bacterial, COVID-19)          
Cystic Fibrosis
Chronic Bronchitis               
Pulmonary Edema
Congestive Heart Failure       
Pre/Post Lung Transplant

Why use an Acapella device?

• Less forceful than coughing, less irritating to pulmonary tissues (Leith, D.)
• Increased FEV1 (marker of lung function)
• Increased sputum production decreases bacterial load and decreases infection risk

How to Use an Acapella:

No evidence-based protocols, use alone or with other interventions.
You can also combine it with postural drainage.

Use in Active Cycle of Breathing, especially if your patient can’t huff well.

You need to tell your patient that this will make them cough! That way, they don’t STOP using it because it made them cough! Getting them to cough is the whole point. They may not tolerate this will at first, so you may need to instruct them to spread out performance over the course of the day to increase tolerance.

Goal: maintain secretion mobility, produce cough, expel secretions

Other common PEP-type devices:

The Aerobika. Although useful and better than nothing, this device doesn’t function if turned upside down so using it in conjunction with postural drainage positions is challenging. However, it will still give the patient some resistance to exhalation with some oscillation to assist in loosening secretion as long as they are upright.

Duet Devices. Allow for all the benefits of a regular PEP device with the addition of the ability to run nebulizer medications through the device at the same time. Read more about that here! This is the standard, but there are other options.

Here is an article that outlines the very basics of different types of devices including PEPs, flutter valves, cough-assists, and more.

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How do you like to combine your pulmonary interventions? Let me know in the comments!

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References:

• Olsen, et al. (2015) Respiratory Medicine Positive expiratory pressure – Common clinical applications and physiological effects. Resp Med: 109, 297-307;
• Gastaldi AC (2016) Flutter Device Review: Effects on Secretion and Pulmonary Function. J Nov Physiother 6: 292. doi:10.4172/2165-7025.1000292.

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