Flutter valve therapy

How does the Acapella Flutter Valve Therapy work? Acapella by Smiths Medical directs exhaled air through an opening which is periodically closed by a pivoting cone. As air passes through the opening, the cone alternates between closing and opening the airflow path, this results in a vibrating pressure waveform.

Flutter valve therapy. Flutter After bioprosthetic valve replacement After mechanical valve replacement Bridging: Valvular AF implies rheumatic VHD with MS or mechanical heart valves, and is considered contraindicating NOACS (11, 13) Anticoagulant therapy for atrial flutter is recommended based on the same risk score (CHADS2-VASC) as that used for …

Jun 25, 2022 ... HPFY's In-House Respiratory Expert, Laura Castricone shares some tips about using Smiths Medical Acapella Vibratory PEP Therapy System.

The two primary varieties of VERVE therapy are flutter valves and acapella breathing devices. Both have being proven effective include discharge lung …Flutter Valve Oscillating PEP Therapy. Click the card to flip 👆. single weighted ball valve with counterweighted lever and magnet. rapidly opens and closes during exhalation, creating positive pressure and oscillating waves in the airways. larger than normal tidal volume and exhales against the flutter. Click the card to flip 👆.10-25 cmH2O. What type of pt seem to benefit the most from intrapulmonary percussive ventilation? Cystic Fibrosis. Intrapulmonary percussive ventilation, Flutter Valve, PEP therapy may be an alternative for what other popular therapy? postural drainage and percussion. List 5 complications of CPT. Hypoxemia.This video shows how to use a Flutter device.Vibratory PEP Therapy System Acapella® Choice Adult. Works independent of orientation. Patient may inhale through the device. 22mm fitting: May use with mouthpiece. Vibratory PEP Therapy System Acapella® Adult 15 lpm Smiths Medical ASD Inc 21-1530.

Present Based. Flutter Gate and Acapella: Notes (PEP Therapy) by John Landry, SS, RRT | Updated: Nova 24, 2023. Positive expiratory pressure (PEP) is adenine type of airway clearance therapy that helps clear mucus from the lungs. Aforementioned twin primary types from PEP therapy are fluttering valves and acapella take auxiliary. Flutter valve. In respiratory medicine, a flutter valve (also Pneumostat valve, and Heimlich valve) is a one-way check valve used to prevent airflow back into a chest tube, and usually is applied to drain air from a pneumothorax. [1] The design of the flutter valve features a rubber sleeve in a plastic case, where the rubber sleeve is arranged ... The Flutter®. This page explains about the Flutter® and what to expect when your child comes to Great Ormond Street Hospital (GOSH). The Flutter® is part of the treatment to help people who have difficulty clearing sputum (phlegm) from their lungs. The equipment consists of a pipe-shaped device made up of four parts: a mouth piece, a ... The Flutter Valve (Varioraw SARL, Scandipharm Inc, Birmingham, AL) has proven efficacy in hypersecretive spontaneously ventilated patients. This study was designed to evaluate whether an airway clearance protocol using the Flutter Valve can affect the therapeutic and physiologic outcomes in mechanically ventilated patients with …This video shows how to use a Flutter device.We would like to show you a description here but the site won’t allow us.Disassemble the device in four parts: the mouthpiece, top case, bottom case and valve cartridge. Soak 15 minutes in soapy water and agitate gently. Rinse with clean water to remove soapy water and contaminants. Shake out the water and dry vertically. The AEROBIKA* OPEP device can also be cleaned with a dishwasher. Place the device in a …

Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are airway abnormalities that share a common feature of expiratory narrowing but are distinct pathophysiologic entities. Both entities are collectively referred to as expiratory central airway collapse (ECAC). The malacia or weakness of cartilage that supports the …Jan 11, 2017 ... Treadmill exercise improved ease of expectoration and Flutter® therapy improved subjective sense of chest congestion. Conclusions. A single bout ...Aug 29, 2023 · A small 2022 study of 50 people living with COPD compared the results of two treatments: drug therapy with OPEP therapy and drug therapy alone. Researchers found that after 3 months, the group assigned to use a flutter valve daily showed improved lung function measurements, increased exercise capacity, and reduced symptoms compared with the ... Flutter is a device you can use to clear your airways by yourself. Blowing into the Flutter helps loosen and move any trapped mucus or secretions. The Flutter is shaped like a pipe with a steel ball on a cone inside. You must hold the Flutter at the right angle to make it work. Blowing into the mouthpiece makes the steel ball rise and fall.The AirPhysio is an easy-to-use, award-winning device that can help clear lungs of excess mucus and restore lung capacity. Ideal for anyone with asthma, COPD, bronchiectasis, and other lung challenges - even chest colds and flu. Simply take a deep breath, then exhale through the device. AirPhysio uses all-natural Oscillating Positive Expiratory Pressure to …Flutter - The Flutter mucus clearance device, manufactured by Aptalis Pharma US Inc, provides PEP therapy for patients with atelectasis, bronchitis, bronchiectasis, cystic fibrosis, COPD, asthma or other …

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Who Can Have the Zephyr Valve Treatment? You may be a candidate for Zephyr Valves if you: Have a confirmed diagnosis of COPD or emphysema. Feel breathless even when …Objective: The Flutter Valve (Varioraw SARL, Scandipharm Inc, Birmingham, AL) has proven efficacy in hypersecretive spontaneously ventilated patients. This study was designed to evaluate whether an airway clearance protocol using the Flutter Valve can affect the therapeutic and physiologic outcomes in mechanically ventilated patients with pulmonary infection.Description. Originally manufactured by Smiths Medical, Acapella Vibratory PEP Devices provide positive expiratory pressure (PEP) therapy to patients with cystic fibrosis, COPD, asthma, atelectasis, or lung secretion issues. As a single-patient PEP therapy device with multiple uses, the Acapella valve assists with managing and dislodging ...The benefits of PEP therapy include the ability to increase and promote airway clearance by preventing airway collapse by stenting the airways 7 or by increasing intrathoracic pressure distal to retained secretions by collateral ... Watford, UK) operates on the same principle as the Flutter, that is, a valve interrupting expiratory flow ...

Honest review of a mucus clearance device by a respiratory therapistThe green flutter valve can be purchased by clicking under the Breathing Aids Section of ... Flutter valve. In respiratory medicine, a flutter valve (also Pneumostat valve, and Heimlich valve) is a one-way check valve used to prevent airflow back into a chest tube, and usually is applied to drain air from a pneumothorax. [1] The design of the flutter valve features a rubber sleeve in a plastic case, where the rubber sleeve is arranged ...EBV therapy is a minimally invasive procedure, potentially providing benefits such as improved lung function and reduced shortness of breath without the usual risks and recovery of traditional surgical treatment. Take this quiz to help determine if you may qualify for this minimally invasive procedure to treat severe emphysema or COPD.Buy Mucus Clearance and Lung Expansion Device, Flutter Valve Mucus Removal Device, Lung Exerciser Device for Lung Strengthener, Breathing Exercise Device for Lungs ... Enjoy the benefits of this drug-free therapy from the comfort of your own home. Optimal Breathing Training: Our product incorporates O2 trainer technology, which helps …The Active Cycle of Breathing Technique Forced Expiration Technique Positive Expiratory Pressure Therapy using Pari PEP Positive Expiratory Pressure Therapy using mask PEP Positive Expiratory Pressure Therapy using Thera PEP Oscillating Positive Expiratory Pressure Therapy using Acapella Oscillating Positive Expiratory Pressure Therapy using Bottle PEP Oscillating Positive Pressure Therapy ...AEROBIKA® OPEP Device Advantage. Reduces COPD readmissions by 28% in the critical 30-day period. Trend toward shorter length of stay. Reduced use of oral corticosteroids and antibiotic treatments. Improves lung function and ventilation in COPD. Reduces post-operative readmissions by 39% in the critical 30-day period.If you’ve ever thought about receiving counseling or participating in therapy, you may wonder what options are available to you. Many different therapy styles can help you with anx...Description and use of the Flutter device. The Flutter de- vice consists of a hardened plastic mouthpiece at one end, a plastic perforated cover at the other end, and a valve on the inside created by a high-density stainless steel ball rest- ing in a plastic circular cone (Fig. 1). When a subject ex-

10-25 cmH2O. What type of pt seem to benefit the most from intrapulmonary percussive ventilation? Cystic Fibrosis. Intrapulmonary percussive ventilation, Flutter Valve, PEP therapy may be an alternative for what other popular therapy? postural drainage and percussion. List 5 complications of CPT. Hypoxemia.

However, equivalent sputum production can be accomplished with autogenic drainage, positive expiratory pressure, and Flutter valve therapy without the assistance of another caregiver, as long as ... Flutter Valve Oscillating PEP Therapy. Click the card to flip 👆. single weighted ball valve with counterweighted lever and magnet. rapidly opens and closes during exhalation, creating positive pressure and oscillating waves in the airways. larger than normal tidal volume and exhales against the flutter. Click the card to flip 👆. SMITHS MEDICAL ASD INC. acapella DM Vibratory PEP Therapy System with Mouth Piece Blue. Learn More. 55001802.JPG. VYAIRE MEDICAL. AirLife One-way Flutter Valve ...The couple primary types of PEP therapy are flutter valves and acapella breathing devices. Both having being proven effective in clearing lung secretions, and how do they work? In this article, we’ll take a close see at PEP therapy and how fluttery valves and acapella devices labour. We’ll also crack down of key, contraindications, and ...The two primitive classes away PEP therapy are flutter valves and acapella breathing contrivances. Both have been proven effective in settlement air secretions, but instructions execute she work? In this article, we’ll take a closer look during PEP therapy and how flutter fittings and acapella devices working. We’ll also break down the ...Flutter - The Flutter mucus clearance device, manufactured by Aptalis Pharma US Inc, provides PEP therapy for patients with atelectasis, bronchitis, bronchiectasis, cystic fibrosis, COPD, asthma or other …Percussive therapy • Flutter valves ... The flutter valve is passively pressed against the end of the lower esophagus when the gastric fundus is filled (Fig. 73-1, A and B). 7 The flatter the angle of His, the less developed is the valve mechanism and …Flutter Valve Demo (Acapella)Introduction. The Flutter is a handheld device designed to facilitate the clearance of mucus in hypersecretory lung disorders. Exhalation through the Flutter results in oscillations of expiratory pressure and airflow, which vibrate the airway walls (loosening mucus), decrease the collapsibility of the airways, and accelerate airflow ...Color-coded units (green for high-flow, blue for low) help customize treatment based on clinical needs. You can adjust acapella's frequency and flow resistance simply by turning an adjustment dial. Acapella Vibratory Valve Features: Color-coded. Blue-DM <15 lpm for 3 seconds. Green-DH >15 lpm for 3 seconds. Inspiratory Valve. 22mm OD ambient end.

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Flutter Mucus Clearance System . Combining PEP therapy with high-frequency oscillation, the Flutter mucus clearance device is a controlled vibration system that gently oscillates the large and small airways in the lungs. Oscillating devices like this create vibrations when you exhale.CPT. ®. 94667, Under Pulmonary Diagnostic Testing and Therapies. The Current Procedural Terminology (CPT ®) code 94667 as maintained by American Medical Association, is a medical procedural code under the range - Pulmonary Diagnostic Testing and Therapies.A flutter valve (known as the Heimlich valve since its creator, Henry Heimlich) is a one-way respiratory valve used in respiratory therapy to prevent air from …August 29, 2023. Content created for the Bezzy community and sponsored by our partners. Learn More. Illustration by Brittany England. by Stephanie Orford. •••••. Medically …AEROBIKA® OPEP Device Advantage. Reduces COPD readmissions by 28% in the critical 30-day period. Trend toward shorter length of stay. Reduced use of oral corticosteroids and antibiotic treatments. Improves lung function and ventilation in COPD. Reduces post-operative readmissions by 39% in the critical 30-day period.Description. Originally manufactured by Smiths Medical, Acapella Vibratory PEP Devices provide positive expiratory pressure (PEP) therapy to patients with cystic fibrosis, COPD, asthma, atelectasis, or lung secretion issues. As a single-patient PEP therapy device with multiple uses, the Acapella valve assists with managing and dislodging ...VibraPEP ® with non-mechanical, flow valve technology converts most of the patient effort into therapy. Requiring 34-54% LESS total lung volume than other OPEP devices. This allows patients to more easily achieve maximum therapeutic benefit from OPEP therapy.Vibratory PEP Therapy System Acapella® Choice Adult. Works independent of orientation. Patient may inhale through the device. 22mm fitting: May use with mouthpiece. Vibratory PEP Therapy System Acapella® Adult 15 lpm Smiths Medical ASD Inc 21-1530.This item may require 1-2 days to ship out from our facility.Product Information: AirLife One-Way Oxygen Therapy Disposable ConnectorManufacturer Part # 001800Description The 22 mm O.D. adapter with tapered hose end contains the one-way valve and connects to 22 mm ID tubing; the other end can be attached to any 22 mm IOne advantage of using an acapella out a flutter valve is that e can be used in any my position, where a flitter valve should only be used while to patient is erected. Indications. The indications for use an acapella, flutter valve, or other classes of PEP therapy include: To help clear mucus; To prevent or reverse atelectasis; To reduce air ...Flutter valve. In respiratory medicine, a flutter valve (also Pneumostat valve, and Heimlich valve) is a one-way check valve used to prevent airflow back into a chest tube, and usually is applied to drain air from a pneumothorax. [1] The design of the flutter valve features a rubber sleeve in a plastic case, where the rubber sleeve is arranged ...Attach one-way valve on the inspiratory end, resistor on the expiratory end. Connect manometer to assemble. Select largest expiratory resistor setting when initiating therapy. 4. Explain procedure to patient. Have patient sit up straight, preferably at a table, with their elbows resting on the table. 5. ….

Color-coded units (green for high-flow, blue for low) help customize treatment based on clinical needs. You can adjust acapella's frequency and flow resistance simply by turning an adjustment dial. Acapella Vibratory Valve Features: Color-coded. Blue-DM <15 lpm for 3 seconds. Green-DH >15 lpm for 3 seconds. Inspiratory Valve. 22mm OD ambient end.May 8, 2018 ... ... therapist) both recommended that I buy a flutter and use it. ... I have an acapella valve (flutter valve) and use it after nebulizer treatments.Flutter. CONCLUSIONS: PEP devices produced ... Flutter valve improves respira- tory mechanics ... The value of physical therapy with VRP 1-Desitin. (“Flutter”).Flutter Mucus Clearance System . Combining PEP therapy with high-frequency oscillation, the Flutter mucus clearance device is a controlled vibration system that gently oscillates the large and small airways in the lungs. Oscillating devices like this create vibrations when you exhale.by John Landry, BS, RRT | Updated: May 7, 2024. Positive expiratory pressure (PEP) therapy is a vital technique for clearing mucus from the lungs, playing a crucial role in managing conditions like cystic fibrosis. This therapy has two main forms: flutter valves and acapella devices, both of which facilitate the removal of lung secretions.Acapella Flutter Valve is a Respiratory and acapella device used for Breathing Therapy that combines the benefits of PEP therapy and airway vibrations to mobilize pulmonary secretions.Manufactured by Portex, the Acapella Vibratory PEP Therapy Flutter Valve can be used sitting down, standing or reclined.Another benefit to PEP therapy and a …Abstract. The Heimlich valve is a small one-way valve used for chest drainage that empties into a flexible collection device and prevents return of gases or fluids into the pleural space. The Heimlich valve is less than 13 cm (5 inches) long and facilitates patient ambulation. Currently there are several systems in the market.The Flutter device was developed in Switzerland and combines positive expiratory pressure therapy with high–frequency oscillations within the airway. It is a ...Vibratory PEP Therapy. Vibratory Positive Expiratory Pressure (PEP) Therapy uses handheld devices such as flutter valves or Acapella devices for patients who need assistance in clearing mucus from their airways. These devices require a prescription and are used in collaboration with a respiratory therapist or advanced health care provider.SKU: 3102000. Description. The Flutter is a small, lightweight mucus clearance device that requires no power and can be used anywhere at anytime. It works by the patient exhaling into the device, this causes the precision steel ball inside the casting to vibrate. The vibrations travel back into the lungs, these vibrations loosen the mucus in ... Flutter valve therapy, The Flutter device is a small pipe-shaped, easily portable handheld device, with a mouthpiece at one end. It contains a high-density, stainless steel ball that rests in a plastic circular cone. During exhalation, the steel ball moves up and down, creating oscillations in expiratory pressure and airflow., Flutter After bioprosthetic valve replacement After mechanical valve replacement Bridging: Valvular AF implies rheumatic VHD with MS or mechanical heart valves, and is considered contraindicating NOACS (11, 13) Anticoagulant therapy for atrial flutter is recommended based on the same risk score (CHADS2-VASC) as that used for …, Description. Originally manufactured by Smiths Medical, Acapella Vibratory PEP Devices provide positive expiratory pressure (PEP) therapy to patients with cystic fibrosis, COPD, asthma, atelectasis, or lung secretion issues. As a single-patient PEP therapy device with multiple uses, the Acapella valve assists with managing and dislodging ..., Four years ago, the FDA approved the first valve system for endoscopic lung volume reduction (eLVR), a minimally invasive alternative to surgical lung reduction for patients with severe chronic obstructive pulmonary disease (COPD) or advanced emphysema. Less than two years later, endobronchial valve therapy was included in the …, EBV therapy is a minimally invasive procedure, potentially providing benefits such as improved lung function and reduced shortness of breath without the usual risks and recovery of traditional surgical treatment. Take this quiz to help determine if you may qualify for this minimally invasive procedure to treat severe emphysema or COPD., Flutter After bioprosthetic valve replacement After mechanical valve replacement Bridging: Valvular AF implies rheumatic VHD with MS or mechanical heart valves, and is considered contraindicating NOACS (11, 13) Anticoagulant therapy for atrial flutter is recommended based on the same risk score (CHADS2-VASC) as that used for …, If you’ve ever thought about receiving counseling or participating in therapy, you may wonder what options are available to you. Many different therapy styles can help you with anx..., CLINICAL IMPLICATIONS: Flutter valve device can be an adjunct to pulmonary rehabilitation especially in low to middle income countries and lower the cost and morbidity associated with the disease. Our study is a pilot study which showed the benefits of use of acapella device at home among severe COPD patients, but is limited due to the low ..., The patient is instructed to inhale deeply and hold his breath for 2 to 3 sec. Expiration should be slow 8 through the Flutter valve, causing oscillations of the steel ball inside the cone of the Flutter (Figure 8). Patients apply repeated exhalations through the Flutter valve. Routinely, three sets of 15 exhalations are performed over 12–20 min. , FLUTTER intervention consisted of connecting the Flutter Valve to the exhalation port of the mechanical ventilator. Control intervention (CTRL) was normal ventilation in pressure controlled mode., Spirometer q hour with flutter valve while awake. Up in chair TID and ad lib, if able Ambulate TID and ad lib, if able ... PT consult RT consult. RT to initiate flutter valve therapy q8hr and PRN. O2 as needed for SaO>=90% PCXR 24 hrs post admission to eval for PTX, HTX Call TRAUMA for: RR > 25/min x 2 consecutive checks SaO2 <90% on 4 …, The two primary types of PEP therapy are flutter valves and acapella breathing devices. Both have been proven effective in clearing lung secretions, but how do they work? Within this blog, we’ll take a closer look at PEP therapy and how flutter valves furthermore acapella devices work. We’ll furthermore break down the display ..., , The Flutter®. This page explains about the Flutter® and what to expect when your child comes to Great Ormond Street Hospital (GOSH). The Flutter® is part of the treatment to help people who have difficulty clearing sputum (phlegm) from their lungs. The equipment consists of a pipe-shaped device made up of four parts: a mouth piece, a ... , What is the range of pressure used for flutter valve therapy? 10-25 cm H2O. What types of patients seem to benefit the most from intrapulmonary percussive ventilation? CF patients. Intrapulmonary percussive ventilation, flutter valve therapy, and PEP therapy may be alternatives for what other popular therapy?, Honest review of a mucus clearance device by a respiratory therapistThe green flutter valve can be purchased by clicking under the Breathing Aids Section of ..., What is an Acapella Flutter Valve? How does it work and what is it used for? Watch the video to find out! 💥Acapella Flutter Valve [Full Guide] https:/... , Nursing management of the patient using flutter valve therapy includes educating the patient to take the correct position, education on the technique of using the flutter valve, the goal, and the outcome of the therapy. Flutter valve therapy is especially induced in patients with cystic fibrosis, where it reduces the viscosity of the mucus ..., 1. Fill a container with warm water and mild liquid soap. Make sure it’s big enough to hold all the Aerobika’s parts. 2. Put the parts in the soapy water and gently swish them around. Let them soak for 15 minutes. 3. Take the parts out of the soapy water. Rinse them with warm running water. , Apr 19, 2024 · 14. Patients can control a flutter valve’s pressure by changing what? Their expiratory flow. 15. Advantages of the flutter valve over other bronchial hygiene methods include all of the following EXCEPT: Greater effectiveness. 16. What is the primary goal of bronchial hygiene therapy? To improve gas exchange and reduce the patient’s work of ... , Flutter Valve Oscillating PEP Therapy. Click the card to flip 👆. single weighted ball valve with counterweighted lever and magnet. rapidly opens and closes during exhalation, creating positive pressure and oscillating waves in the airways. larger than normal tidal volume and exhales against the flutter. Click the card to flip 👆., AEROBIKA® OPEP Device Advantage. Reduces COPD readmissions by 28% in the critical 30-day period. Trend toward shorter length of stay. Reduced use of oral corticosteroids and antibiotic treatments. Improves lung function and ventilation in COPD. Reduces post-operative readmissions by 39% in the critical 30-day period., Pulmonary Therapy 2017; 3(1): ... Remove valve cartridge and mouthpiece. Soak 15 minutes in soapy water, agitate gently and rinse. Shake out water and dry vertically or place in a dishwasher basket on the top rack after performing cleaning instructions 1 and 2. Full dishwasher instructions can be found with the complete instructions for use ..., Acapella Flutter Valve-Green Hi Flow. $ 49.00. SKU: 21-1530 Categories: Respiratory Accessories, Respiratory Therapy. Add to cart. Description. Additional information. Smiths Medical. Acapella® combines the benefits of both PEP therapy and airway vibrations to mobilize pulmonary secretions and can be used in virtually any spatial orientation., The small ergonomic design of this Breathing Therapy device helps users easily hold the Aerobika OPEP in the palm of their hand. As the user exhales through the Aerobika flutter valve, they will feel short pulses of resistance against exhaled breath as the mucus loosens and encourages forceful "huff" coughs. The Aerobika valve provides the ..., Honest review of a mucus clearance device by a respiratory therapistThe green flutter valve can be purchased by clicking under the Breathing Aids Section of ..., Acapella Flutter Valve is a Respiratory and acapella device used for Breathing Therapy that combines the benefits of PEP therapy and airway vibrations to mobilize pulmonary secretions.Manufactured by Portex, the Acapella Vibratory PEP Therapy Flutter Valve can be used sitting down, standing or reclined.Another benefit to PEP therapy and a …, Bronchopulmonary Hygiene Therapy. Improved clearance of mucus is the cornerstone of the management of bronchiectasis and includes several components. They include: Inhaled medication (bronchodilator and/or inhaled steroid, saline) and/or. Airway clearance measures (oscillating positive expiratory pressure device, high-frequency chest wall ..., In a randomized crossover study of 20 patients with cystic fibrosis published in 1992, Lindemann found Flutter therapy to be equal to AD for mucus expectoration. 24 In addition, he identified the following advantages to therapy with the Flutter valve: It is easy to teach and learn. It can be taught from early childhood on., The patient is instructed to inhale deeply and hold his breath for 2 to 3 sec. Expiration should be slow 8 through the Flutter valve, causing oscillations of the steel ball inside the cone of the Flutter (Figure 8). Patients apply repeated exhalations through the Flutter valve. Routinely, three sets of 15 exhalations are performed over 12–20 min. , SKU: 3102000. Description. The Flutter is a small, lightweight mucus clearance device that requires no power and can be used anywhere at anytime. It works by the patient exhaling into the device, this causes the precision steel ball inside the casting to vibrate. The vibrations travel back into the lungs, these vibrations loosen the mucus in ..., What is a Flutter Valve? A flutter valve is a small, handheld device that is pre-owned to helped clear saliva from the lungs. It’s the most commonly type of oscillatory PEP therapy the is commonly spent inside patients using cystic fibrosis. This device is triangular-shaped for a floating steel ball inside., THE BREATHER │ Natural Breathing Exerciser Trainer For Drug-Free Respiratory Therapy │ Breathe Easier with Stronger Lungs │ Guided Mobile Training App Included. ... Following aspirating twice within 3 weeks I was told use this flutter valve clearing device. The pulmonologist told me to start using lung expanding and mucus …