Clinical Research Directory

The patient begins by performing the diaphragmatic breathing at low lung volume inspiration will slow with a pause of three seconds allowing the collateral ventilation, and expiration will done as a sigh with an open glottis and with high velocity as possible but no forced expiration. During this low lung volume breathing, expiration will encourage to the expiratory reserve volume. When the patient feel secretions to be moving, the volume of inspiration became deeper and expiration did not go down as far as expiratory reserve volume. As the secretions moved up the bronchial tree to the large airways then the patient will ask to perform higher lung volume breathing, tidal volume to inspiratory reserve volume range. This middle to high lung volume breathing continued until the secretions will in the trachea and ready to be expectorated

The flutter device will hold horizontally and tilted slightly upwards to get maximal oscillatory effect and then it was placed in the mouth. Inspiration was done through the nose. A slow breath in, only slightly deeper than normal with a breath hold of 3-5 seconds will followed by breath out through the flutter device at a slightly faster rate than normal. After 4-8 breaths, a deep breath with a hold' at full inspiration will followed by a force expiration through the flutter device. This precipitated expectoration and will followed by a pause for breathing control, and then according to the subjects' preference a cough or huff was done