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Vibrating PEP (Acapella)

do any of you use one of these? If so how does it work for you? Is it very helpful?

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Comments 87

  • GigiGibson

    That's it! No, my doctor and I haven't discussed it. I found it when working to get a patient an airway clearance vest. Before you can get a vest you have to try and fail those devices. I checked it out on you tube and wonder if it could help us. 

  • K8sMom2002

    I think it's something to ask the doctor about! I know mucus is one of my worst things, especially when I get a good bout of bronchitis or pneumonia going. 

    Thanks for sharing!

  • Brian Cushing

    I have asthma, which is 'well controlled' much of the time, but is generally less controlled during December and January. I also have chronic bronchitis, which means that my mucus production in my airways is always somewhat of an issue. The acapella device definitely helps me to clear the mucus when it starts becoming a problem. I take 400 mg of quifenesen every six hours with a full glass of water as well; this also helps to make it easier to clear the mucus with the acapella device. 

  • K8sMom2002

    Thanks for sharing, Brian, and welcome to AAFA's Asthma Support community! How long have you used the acapella device? Did your doctor recommend it?

    And you use this on as as-needed basis?

  • Brian Cushing

    I am with an HMO; they provided it through the pharmacy at a low co-pay ($5, I think). Check out shopnebulizer.com; they have inexpensive spacers. 

  • Brian Cushing

    I am with an HMO; they provided it through the pharmacy at a low co-pay ($5, I think). Check out shopnebulizer.com; they have inexpensive spacers. 

    My pulmonologist first prescribed the acapella several years back. I only use it when my mucus production becomes a problem (mostly this time of year). The HMO did provide it through their pharmacy with a co-pay; I don't remember how much it was, though. 

    It does help; you can also use palpation/percussion to help clear mucus, if you don't have access to an acapella device. That does work as well. You have to learn how to do it right, though, so you don't hurt yourself or someone else! 

  • Brian Cushing

    The other thing to think about is using breathing exercises. Try to blow out using 'saxophone lips' when exhaling and push as much of the air out of your lungs as you can. If you get in the habit of breathing this way during mild flares, you'll trap less air in your lungs during flares and feel less short of breath as a result. Works for me, anyway! By the way, the acapella device trains you to do pretty much this same thing. 

  • K8sMom2002

    So what does the acapella device actually feel like? Is it uncomfortable?

    I know that I've gotten my DH to rap lightly on my back to loosen my chest up when I have that thick mucus that feels like it won't move … it's good to know that there may be options for that.

  • Brian Cushing

    The acapella just creates a vibrating turbulence and back-pressure when you breathe into it. It also trains you to use 'saxophone lips' when exhaling – sort of like trying to whistle each time you exhale. It wouldn't seem like it would help much, but it really does! Again, I would take quifenesen tablets along with using it, to keep the mucus more fluid, if you tolerate those OK. The tablets are available over the counter; I use the ones without the added dextromethorphan; the last thing I want to do is restrict my coughing when I am dealing with a mucus issue!  

  • K8sMom2002
    Brian Cushing posted:

     the last thing I want to do is restrict my coughing when I am dealing with a mucus issue!  

    I have found that most cough suppressants really mess me up if I am dealing with any sort of chest congestion or mucus. I want it out of there!

    At the same time, it's weird — If I have a random coughing fit, it can actually trigger an asthma attack. 

    I will have to talk to my doctor about this device and see if it would help me during times when I'm really battling a lot of chest congestion and mucus. 

  • GigiGibson

    I think trapping is one of my problems. My co2 runs high when stable and really high during attacks. I use techniques similar to sax breathing to help. It work. I think I'll talk to my doc about ordering an acapella. Thanks Brian 

  • GigiGibson

    The last visit was about inhaling via nose then shhh shhh shhh real forceful. One of the paramedics taught me to take a deep breath and blow hard like the trumpet. The back  pressure on your lungs expands them and breathing out purposefully helps. The total process slows down any hyperventilation. That's my take away. 

  • Brian Cushing

    Yes! That's what I kinda meant by 'saxophone lips' – blowing out like you're playing a wind instrument. It helps to push the air as far out as you can. This definitely cuts down on the trapped air in your lungs, and the result will hopefully be less shortness of breath. At least that works for me. 

  • K8sMom2002

    My mom used that technique for her COPD, and it really did help. I wish we'd known about the Acapella for her! 

    Gigi, are you what is known as a CO2 retainer? My mom was — it made a difference when she wound up on a ventilator and in the way her oxygen settings were done.

    The first time she ever wound up on a vent, they didn't know she was a COretainer and the doctors at the small hospital where she was had her settings wrong for that. They couldn't wean her off the vent. They called in a consulting pulmonologist, and he immediately diagnosed the problem, began fiddling with the vent controls, and voila! Things began to improve and we had her off the vent the next day. He saved her life.

    He told us it was very important to let medical staff and EMTs know she was a CO2 retainer. I'm not sure exactly what the difference was or why it mattered — but it's something to talk with your doctors about.

  • K8sMom2002

    I would ask your doctor about that and also ask if you need a specific ER plan that you can take with you.

    It has to do with how COretainers' drive to breathe can be affected by excess oxygen. With my mom, our pulmonologist told us that the settings of the vent were for "normal people," but for my mom, too much oxygen could actually cause her to breathe less. 

    It's important for EMTs to know this as well. That's another reason that I would flag your 911 address and have some way of alerting any responding EMT that your doctor has a written plan for how to proceed in the event you have to call an ambulance. 

  • Jen

    Dh has one of those!  I just didn't know it had a name.  He got that, along with a mini peak flow meter, after his lung cancer surgery.  They had him use both to do lung exercises to help him deal with reduced lung capacity after having his upper right lobe removed.  I don't think he uses them any more, but he is now 4 years out from surgery.

  • K8sMom2002

    I shall have to ask my doctor about this gadget — Gigi, keep me posted if you try it out. I think for someone like me, who winds up with a lot of congestion and mucus during a flare, it could help. 

  • K8sMom2002

    Gigi, what have you decided about the Acapella? Are you going to talk it over with your doctor? 

  • GigiGibson

    We talked today (asthma/allergist). He said he saw it mainly used with cf patients so to ask my pulm. 

  • Brian Cushing

    It's true that chronic bronchitis (COPD) and cystic fibrosis patients are most likely to have the kind of mucus production to be most problematic, but if your asthma also produces heavy mucus, then this device will help clear it. In my case, I take lots of guifenesen (Musinex) as well, in order to thin the mucus and facilitate its removal. 

  • Jen

    Gigi – Have you had a chance to ask your pulmonologist about this?

  • K8sMom2002

    So, Gigi, is the guaif doing the trick still? Or are you still thinking of asking your doc about the Acapella? For someone like me, who has a lot of mucus when my asthma flares up, it might be a good option. *circles back to jot down a reminder to ask my doctor*

  • K8sMom2002

    Gigi, is the guaif still working for you? What sort of side effects does it have? I am particularly sensitive to any sort of drug that has a sedative effect, and also drugs like Sudafed can totally screw up my sleep.

    I still remember when DD was little how the doctor prescribed her a cough med for one of her times with bronchitis. It was SUPPOSED to help her sleep, but unfortunately it had the exact opposite effect. I had an awake, cranky, sleep-deprived toddler bouncing off the walls! I called the doctor and asked and he said, "Well, yeah, sometimes it does that."

  • Kathy P

    I've never noticed any side effects from guaif. It is important to stay hydrated though as it need the fluids to be able to thin the mucus.

  • Brian Cushing

    That's a great point, Kathy. The guaifenesen won't work if you don't hydrate. It requires fluids to be effective. I take it every day. 

  • GigiGibson

    I read some scary article yesterday about plugs and ordered an acapella pep, it will be in Tuesday. 

  • Jen

    Gigi – Do you have a link to the article?  Curious as to what it said regarding the plugs.  Also looking forward to your feedback n the acapella pep.

  • GigiGibson

    Fatal asthma

    Two different patterns of fatal asthma have been described (Table (Table1).1). The greater number of deaths from asthma (80–85%) occurs in patients with severe and poorly controlled disease who gradually deteriorate over days or weeks, the so-called 'slow onset – late arrival' or type 1 scenario of asthma death [2,3,4,16,17,18]. This pattern of asthma death is generally considered preventable. A variation of this pattern is a history of unstable disease, which is partially responsive to treatment, upon which a major attack is superimposed. In both situations, hypercapnic respiratory failure and mixed acidosis ensues and the patient succumbs to asphyxia, or if mechanical ventilation is applied, to complications such as barotrauma and ventilator-associated pneumonia. Pathologic examination in such cases shows extensive airways plugging by dense and tenacious mucous mixed to inflammatory and epithelial cells, epithelial denudation, mucosal edema, and an intense eosinophilic infiltration of the submucosa. In a small proportion of patients, death from asthma can be sudden and unexpected (sudden asphyxic asthma), without obvious antecedent long-term deterioration of asthma control, the so-called 'sudden onset' or type 2, scenario of asthma death [18,19,20,21]. Affected individuals develop rapidly severe hypercapnic respiratory failure with combined metabolic and respiratory acidosis, and succumb to asphyxia. If treated (medically and/or mechanically ventilated), however, they present a faster rate of improvement than patients with slow-onset asthmatic crisis. Pathologic examination in such cases shows 'empty' airways (no mucous plugs) in some patients, and in almost all patients, a greater proportion of neutrophils than eosinophils infiltrating the submucosa is observed [20,21,22].

     

  • K8sMom2002

    Oh, wow, Gigi … that's an eye-opening article. Have you shared it with your pulmologist to see what he says about it? I really wish I were better at reading the details of a study to see, "okay, yeah, this study has some issues with the way it did its selection of participants/subjects," or "okay, this study made sure that it did a good job with how it structured things."

    Looking forward to your review of the Acapella … I hope it works!

  • Jen

    Did you ever discuss what you read in that article with your pulmonologist?

  • GigiGibson

    No. I figured I need to stay on top of it myself but taking the guaif and doing the acapella when I start tapering down. I got back on it today with both. It's usually when I get down to 10mg I get "pluggy"

  • Brian Cushing

    Gigi, how much guifenesen are you taking? And are you tapering off of prednisone? Are you using a steroid inhaler like Flovent, Qvar, or one of the LABA/steroid combinations? If so, how is it working for you? 

    I am one of the unfortunate people who cannot use the LABA inhalers. They dilate my tubes OK, but they also kick up my mucus production, and this problem offsets the benefit. I use albuterol, Atrovent, and Flovent inhalers, and this seems to be working to maintain me at the 'well controlled' level most of the time. My allergist wants me to try theophilline instead of the albuterol, though. I guess he's concerned about long term effects of albuterol on my heart. So far so good, though! I'm 64 years young, I've had asthma for almost 30 years, and I'm still pretty active. 

  • GigiGibson

    I'm spreading the guaif over a day total 200-600. I take xolair, qvar, singulair, symbicort, duonebs TID , budesonide bid, proair prn and albuterol nebs prn. 

    I just rechecked my note and he said go from 20bid d 5 days to 20 mg qd x 5 days,oh lord I'm nervous now. 

    I usually don't have any mucus but when I am tapering I hit a spot of thick viscous mucus so I will be ver diligent with my guaif, probably 200 mg qid. 

    Any tips?

  • Brian Cushing

    Seems like a big step, 20 BID to 20 QD. I would ask if 15 BID might be better for a few days at least. Docs these days want to get us off the oral steroids quickly; I'd have to say that every time my allergist has prescribed a rapid taper I've convinced him to let me 'smooth' it out a bit. If you're not having crazy side effects on the pred, you might discuss stretching the taper a bit with your doc, especially if you're still struggling for control of the flare. Only you truly know what works for you. Be sure to take your vitamin D and eat your calcium-rich foods while you're on the pred! Green leafy vegetables are best, along with some dairy if you tolerate that. And avoid sugar of any kind! Pred can make your blood sugar spike; it does that to me. 

    When I'm flaring, I take 400 mg guaifenesin every four hours with lots of water; works for me. No side effects whatsoever. Check with your doc on that. Gotta keep that mucus loose and moving!  Do you think that the singulair helps you? 

  • Kathy P

    That is a big jump! Could he have meant OD instead of QD? Halving to once a day seems reasonable.

  • K8sMom2002

    to what Brian and Kathy P have said … I've never seen a taper that's written quite like that. Can you call back and talk to the nurse at least?

    Glad the Acapella is working! Fingers crossed that it will get you through the thick mucus. Drinking fluids to thin the mucus is the advice I've gotten from my doctor.  

    Brian, my mom was on theophylline — I'd forgotten about that.