EFFORTS - P. O. Box 20241 Kansas City, Mo. 64195-0241 Ph: 1-866-END-COPD


by Richard D. Martin, Editor COPD-NEWS


Article used with permission.
Some of us have problems expelling thick mucus. Although many of us do not have this problem, there is a chance we may develop this problem later in our COPD journey or during an illness. There are medications (both over-the-counter and prescription) as well as coughing techniques that can help us expel stubborn mucus. In some cases, our doctors or respiratory therapists might recommend we use a hand-held mechanism that vibrates and loosens the mucus to make it easier to cough out. These small devices vibrate when we breathe into them and are known by various names, such as "percussive airway devices," or "vibratory positive expiratory pressure (PEP) devices." They use vibrations and air pressure to reduce the thickness of mucus. Although the devices are used more commonly for individuals with Cystic Fibrosis and bronchiectasis, they are also used to help those of us with COPD who have difficulty getting rid of mucus.

There are a number of brands of PEP devices on the market. They all require a prescription. The most commonly recognized brands are Acapella, Flutter, Lung Flute, and Quake, although there are others. Your doctor or respiratory therapist might recommend a particular brand for a specific reason. In some cases, they actually keep a small supply on hand and dispense them directly to patients. It pays, however to be familiar with the major brands. If you want to see pictures of these devices, they can be found at the following site for people with cystic fibrosis:


If you are prescribed a device be sure to have your doctor teach you how to use it properly, and do not just blow into them!


There are a large number of websites that offer the Acapella. Prices range from about $55.00 to $100. To learn more about the Acapella, visit the manufacturer's web site at:


Flutter or Flutter Valve

The "Flutter" is a brand name as well as a term that is sometimes used loosely to describe all the PEP devices. A totally different piece of medical equipment is also called the Heimlich flutter valve. It is not a PEP. To add to the already existing confusion, some sites sell what they call "Acapella Flutter Valve" to attract buyers. Flutter Valves are widely available, and you can read about this device on the manufacturer's web site:


Lung Flute

This is the newest of the devices mentioned. It only received FDA approval in January, 2010 and hit the market in February. The Flute creates vibrations to loosen the mucus by passing air over a reed. The device is available for $45.00, and includes a 6 month's supply of reeds. An additional 6 month's supply of reeds is $16.50. You can order them directly

(prescription needed) from the manufacturer at:



The Quake has been around for about 5 years. In a study published in 2007 in Chest, the journal of the American College of Chest Physicians, researchers compared the Acapella, Flutter and Quake. The Lung Flute was not included because it wasn't available then. They found that the, "Quake generated sufficiently stronger pressure pulses than the Acapella and Flutter." It must be pointed out that although the study was conducted by researchers associated with the Quake's manufacturer Thayer, it appeared in a trusted, peer reviewed journal. The study is available at:


The Quake is not available over the Internet, but it very widely available. You can find your nearest supplier by calling 800-250-3330. You can also get it through major oxygen providers. If all else fails, you can order it from the Wilmot Pharmacy in Tucson, Arizona (520-721-3088). The suggested retail price is $54.50, but the price may vary depending on the dealer. For

more information about the Quake, visit the manufacturer's web site: