ACCP Does Not Provide Specific Recommendations for IS, EzPAP, or Acapella
The American College of Chest Physicians (ACCP) does not have published guidelines specifically recommending incentive spirometry (IS), EzPAP, or Acapella devices for any patient population. The available ACCP evidence addresses these devices only in the context of chronic cough due to bronchiectasis, where bronchopulmonary hygiene techniques are discussed generally without device-specific recommendations 1.
What the ACCP Actually Says
Bronchiectasis Patients
In their 2006 bronchiectasis guidelines, the ACCP recommends:
- Chest physiotherapy should be used in patients with conditions associated with hypersecretion of mucus and inability to expectorate effectively 1
- Patients should be monitored for symptom improvement
- This is a weak recommendation based on expert opinion (Grade E/C)
The ACCP does not specify which devices or techniques to use—they simply acknowledge that bronchopulmonary hygiene techniques (including chest percussion, vibration, postural drainage, mechanically assisted cough, and airway oscillation) are commonly used but have only modest effects on increasing sputum volume with unknown long-term effectiveness 1.
What Other Guidelines Say
British Thoracic Society (More Specific)
The BTS 2019 bronchiectasis guideline provides more detailed airway clearance recommendations 2:
- Active Cycle of Breathing Techniques (ACBT) is the most commonly taught technique (91% of UK physiotherapists use it routinely)
- ACBT is as effective as oscillating PEP devices for sputum clearance
- Oscillating PEP devices like Acapella are used much less frequently than ACBT
- During exacerbations, patients should be seen daily by a respiratory physiotherapist until airway clearance is optimized
Post-Surgical Context
For pulmonary lobectomy, the 2021 French guidelines found 3:
- Multimodal physiotherapy (early mobilization, walking, breathing exercises, coughing techniques) is recommended
- Adding incentive spirometry or vibratory expiratory pressure devices (like Acapella) to standard multimodal management showed no additional benefit
- These isolated techniques should not be applied alone
Clinical Context from Research
Recent studies show:
- EzPAP and Acapella are comparable to IS for post-surgical lung expansion 4, 5
- OPEP devices may improve spirometry and exercise capacity in stable COPD when added to standard therapy 6
- EzPAP may be comparable to NIV for COPD exacerbations in emergency settings 7
Common Pitfalls
- Assuming ACCP has device-specific recommendations: They don't. Their guidance is general about airway clearance techniques
- Using these devices in isolation: Evidence suggests multimodal approaches are superior
- Applying bronchiectasis recommendations to other conditions: The limited ACCP guidance is specific to mucus hypersecretion with impaired expectoration
Bottom Line
If you need device-specific guidance, refer to the British Thoracic Society guidelines for bronchiectasis 2 or surgical recovery guidelines 3, not ACCP. The ACCP's position is simply that some form of bronchopulmonary hygiene should be used in patients who cannot clear secretions effectively, without mandating specific devices 1.