Recommended Frequency for Using Acapella Positive Expiratory Pressure Device
The frequency of Acapella use should be tailored to the individual patient's needs, with once or twice daily treatment commonly recommended, and increased frequency during periods of exacerbation. 1
General Usage Guidelines
- The British Thoracic Society (BTS) recommends that airway clearance techniques, including oscillating positive expiratory pressure devices like Acapella, should be performed for a minimum of 10 minutes up to a maximum of 30 minutes per session 1
- Continue the treatment until two clear huffs or coughs are completed, indicating effective airway clearance 1
- For patients with bronchiectasis, once or twice daily treatment is commonly recommended during stable periods 1
- Increase frequency during infective exacerbations when secretion production is higher 1
Evidence Supporting Acapella Use
- Oscillating positive expiratory pressure (Acapella) is effective and safe to use during acute exacerbations 1
- Acapella improves quality of life, sputum volume expectorated, and exercise capacity compared with no airway clearance technique over a 3-month period 1
- Acapella is more effective at clearing sputum than threshold inspiratory muscle trainers 1
- Setting 4 has been identified as optimal for all Acapella devices (Choice, Green, and Blue) to achieve the ideal vibration frequency of 12-15 Hz for secretion mobilization 2
Optimal Device Settings
- Acapella devices can produce clinically adequate values of mean pressure (10-23 cm H2O) and oscillation frequency (8-21 Hz) when used at optimized conditions 3
- The ideal frequency for secretion mobilization is approximately 13 Hz, which can be achieved with proper device settings 2, 3
- Acapella devices elicit higher vibration amplitudes (5-8 cm H2O) than alternatives like water bottles (1.8 cm H2O), potentially making them more efficient for secretion mobilization 2
- Performance characteristics differ across flows and resistance settings, with increasing flow typically maintaining or increasing the production of mean pressure, peak pressure, and oscillation frequency 4, 5
Patient-Specific Considerations
- Consider patient preference and adherence when recommending an airway clearance technique 1
- Include the forced expiration technique (huff) with all airway clearance techniques to enhance effectiveness 1
- Consider gravity-assisted positioning (where not contraindicated) to enhance the effectiveness of airway clearance 1
- For patients with ongoing hemoptysis, refer back to the respiratory physiotherapist to determine the optimum airway clearance technique 1
Common Pitfalls and Caveats
- Avoid treatment sessions that are too long, as this may lead to patient fatigue and reduced effectiveness 1
- Balance treatment duration to maximize airway clearance without causing fatigue 1
- Different Acapella models (Choice, DM, DH) have different performance characteristics; ensure the appropriate model is selected based on the patient's expiratory flow capabilities 4, 5
- Recognize that increasing the resistance setting doesn't always increase all performance parameters uniformly across different device models 4
By following these guidelines, clinicians can optimize the use of Acapella devices for airway clearance, potentially improving patient outcomes related to respiratory function and quality of life.