Peps and Flutters

In November we had a very interesting talk from Samantha Sladden, a Physiotherapist from the Thanet Pulmonary Rehab team. Sam came to talk about methods and devices to help bring up mucus (phlegm). She reminded us that that everyone's phlegm is different but it should not be hard and lumpy. Sam’s first advice is to drink plenty of fluids to thin the mucous and make it less "sticky". We should all be drinking 2 litres a day but remember that fruit juices contain lots of sugar and also NOT caffeinated drinks such as tea and coffee which are dehydrating. There were howls of protest when she suggested we drink a max of 2 cups a day but the good news is decaf tea and coffee are not a problem so have as much as you like of those. It’s important to use the active cycle of breathing (huffing) as demonstrated at Rehab talks. If you are still unable to clear your chest and are getting repeated infections, a respiratory physio can assess and help you, starting very simply by putting a straw into 4 inches (10cms) of water in a glass and blowing through it. If you can manage this you may be supplied with a flutter device which looks like a clay pipe with a ball bearing which is raised by blowing the pipe. Both methods set up a vibration through the airways which helps loosen phlegm in the chest. The flutter device she showed us costs £56 to the NHS so it’s definitely better to "train" with the straw and glass of water first - probably healthier too as there will be no issues with cleaning it between uses! A flutter device is a PEP (positive expiratory pressure) device. There are drugs which can help loosen mucous but not everyone gets on with those and she reminded us that they can take a month or so to show any results. Sam also showed us a salt-pipe which is not supplied on the NHS and explained how these may help. (Hers cost £50 and lasts 5 years) She also showed us an inspiratory muscle trainer. If you think one of these devices may be of help to you do talk to your respiratory nurse about it.

Peps, Flutters and Salt Pipes

Our April meeting saw Kiri Moseley from the Respiratory Team demonstrating Pep and Flutter devices as well as Salt Pipes to the group. In a highly informative and very well attended meeting, Kiri explained that the Pep and Flutter devices can be used to help mobilize sputum for those who find it a problem to cough up. The way these devices work is that you breathe out against a pressure (normally breathing out is totally passive) which uses more muscles and causes pressure to ‘back fill’ the lungs getting behind the sputum and splinting the airways open, getting further down and helping to shift the sputum. The advantage of the Pep is that it can be used in any position including lying down whereas the Flutter has to used sitting upright and held in the correct position. Some of the Peps also have variable pressure which you can increase as you become more used to it. The Flutter, however, makes quite a satisfying noise which some people like and it vibrates which may help to shake the sputum loose. Both devices can be quite expensive and a cheap alternative can be to breathe out through a straw into a glass of water blowing bubbles. Kiri stressed however, that although these devices can help, none of them replace the Active Cycle of Breathing which is still the cheapest and most effective way of removing sputum from the lungs. Exercise in general and walking in particular is also extremely important for loosening and coughing up sputum. Kiri went on to talk about the Salt Pipe which is a type of inhaler filled with salt. It’s supposed to help asthma, sinusitis, catarrh, snoring, hay fever and sometimes even eczema. It is thought that the salt removes contaminants from the air we breathe and in the lungs. It was noted that people that worked in salt mines didn’t get respiratory diseases. Inhaling salt and salt moist air cleanses the lungs and nasal cavities, calms and relieves inflammation and also the sinuses. Inhaled salt draws water into the sputum which thins the sputum and also makes it easier to expel.