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Efeitos agudos da oscilação oral de alta frequência sobre parâmetros cardiorrespiratórios na DPOC: comparação entre os equipamentos Flutter VRP1 e Shaker

Acute effects of high-frequency oral oscillation on cardiorespiratory parameters in COPD: comparison between the equipments Flutter VRP1 and Shaker

Evelize Cristina Labegaline da Silva Araújo, Eliane Regina Ferreira Sernache de Freitas, Rafael Mesquita, Vanessa Suziane Probst, Álvaro Nagib Atallah

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Introdução: Os efeitos agudos da técnica de Oscilação Oral de Alta Frequência (OOAF) sobre parâmetros cardiorrespiratórios em indivíduos com Doença Pulmonar Obstrutiva Crônica (DPOC) ainda são pouco conhecidos. Objetivo: Avaliar os efeitos agudos da OOAF sobre parâmetros cardiorrespiratórios em indivíduos com DPOC e; verificar se esses efeitos são similares entre os equipamentos Flutter VRP1 (importado) e Shaker (nacional). Métodos: Cem indivíduos com DPOC estável foram randomizados em dois grupos, de acordo com o equipamento para OOAF utilizado: grupo Flutter (GF, n=50), ou grupo Shaker (GS, n=50). Ambos realizaram 15 minutos de OOAF e, antes e após essa intervenção, tiveram avaliadas as variáveis dispneia, frequência respiratória (FR) e frequência cardíaca (FC). Resultados: Observou-se redução de 1 (1 – 3) para 0,5 (0 – 2) pontos na dispneia (p<0,001), de 20 (20 – 24) para 20 (17 – 20) respirações por minuto (rpm) na FR (p=0,002) e de 80 (68 – 84) para 76 (68 – 80) batimentos por minuto (bpm) na FC (p=0,2) após a técnica de OOAF no GF. Não houve diferença estatística significante na comparação entre GF e GS em nenhuma das variáveis investigadas (dispneia: -1 [-2 – 0] vs -1 [-1,3 – 0] pontos, p=0,5; FR: -2 [-4 – 0] vs -0,5 [-4 – 0] rpm, p=0,8 e; FC: 0 [-8 – 4] vs -2 [-8 – 8] bpm, p=0,9; respectivamente). Conclusão: Uma sessão de apenas 15 minutos de OOAF permitiu a melhora de parâmetros respiratórios em indivíduos com DPOC estável, porém sem efeito sobre o parâmetro cardíaco avaliado. Além disso, esses resultados foram semelhantes entre os equipamentos importado e nacional.


Doença Pulmonar Obstrutiva Crônica; Oscilação Oral de Alta Frequência; Dispneia; Frequência Respiratória; Frequência Cardíaca.


Introduction: The acute effects of the High-Frequency Oral Oscillation (HFOO) technique on cardiorespiratory parameters in subjects with Chronic Obstructive Pulmonary Disease (COPD) are poorly known. Objective: To evaluate the acute effects of the HFOO technique on cardiorespiratory parameters in subjects with COPD and; to verify whether these effects are similar between the Flutter VRP1 (imported) and Shaker (national) equipments. Methods: A hundred subjects with stable COPD were randomized into two groups according to the equipment used for HFOO: Flutter group (FG, n=50), or Shaker group (SG, n=50). Both groups performed the HFOO technique during 15 minutes and, before and after this intervention, dyspnea, respiratory rate (RR) and heart rate (HR) were assessed. Results: It was observed a reduction from 1 (1 – 3) to 0.5 (0 – 2) points in dyspnea (p<0.001), from 20 (20 – 24) to 20 (17 – 20) breaths per minute (breaths·min-1) in RR (p=0.002) and from 80 (68 – 84) to 76 (68 – 80) beats per minute (beats·min-1) in HR (p=0.2) after the technique of HFOO in FG. No statistical difference was found in the comparison between FG and SG in any of the investigated variables (dyspnea: -1 [-2 – 0] vs -1 [-1.3 – 0] points, p=0.5; RR: -2 [-4 – 0] vs -0.5 [-4 – 0] breaths·min-1, p=0.8; HR: 0 [-8 – 4] vs 2 [-8 – 8] beats·min-1, p=0.9; respectively). Conclusion: One session of only 15 minutes of HFOO yield improvements in respiratory parameters in patients with stable COPD, but with no effect on the cardiac parameter assessed. Furthermore, these results were similar between the imported and national equipments.


Chronic Obstructive Pulmonary Disease; High-Frequency Oral Oscillation; Dyspnea; Respiratory Rate; Heart Rate.


1. Celli BR, MacNee W., ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004 Jun;23(6):932-46.

2. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55.

3. Garrod R, Lasserson T. Role of physiotherapy in the management of chronic lung diseases: an overview of systematic reviews. Respir Med. 2007 Dec;101(12):2429-36.

4. Ferguson GT. Recommendations for the management of COPD. Chest 2000 Feb;117(2 Suppl):23S8S.

5. Myers TR. Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respir Care. 2007 Oct;52(10):1308-26.

6. Pryor JA. Physiotherapy for airway clearance in adults. Eur Respir J. 1999 Dec;14(6):1418-24.

7. McIlwaine M. Physiotherapy and airway clearance techniques and devices. Paediatr Respir Rev. 2006;7 Suppl 1:S220-S222.

8. App EM, Kieselmann R, Reinhardt D, Lindemann H, Dasgupta B, King M, Brand P. Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage. Chest. 1998 Jul;114(1):171-7.

9. Konstan MW, Stern RC, Doershuk CF. Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. J Pediatr. 1994 May;124(5 Pt 1):689-93.

10. Burioka N, Sugimoto Y, Suyama H, Hori S, Chikumi H, Sasaki T. Clinical efficacy of the FLUTTER device for airway mucus clearance in patients with diffuse panbronchiolitis. Respirology. 1998 Sep; 3(3):183-6.

11. Homnick DN, Anderson K, Marks JH. Comparison of the flutter device to standard chest physiotherapy in hospitalized patients with cystic fibrosis: a pilot study. Chest. 1998 Oct;114(4):993-7.

12. Jones A, Tse E, Cheung L, To C, Lo C. Restoration of lung volume using the Flutter VRP1 or breathing exercise. Aust J Physiother. 1997;43(3):183-9.

13. Wolkove N, Kamel H, Rotaple M, Baltzan Jr MA. Use of a mucus clearance device enhances the bronchodilator response in patients with stable COPD. Chest. 2002 Mar;121(3):702-7.

14. Pryor JA, Prasad SA. Physiotherapy for respiratory and cardiac problems. 4 ed. Edinburgh: Churchill Livingstone; 2008.

15. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of COPD: revised 2011 Feb 21 [Internet]. 2011 [cited 2012 Aug 31]. Available from:

16. Alves LA, Pitta F, Brunetto AF. Performance analysis of the Flutter VRP1 under different flows and angles. Respir Care. 2008 Mar;53(3):316-23.

17. Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes para Testes de Função Pulmonar. J Pneumol. 2002 May;28(Suppl 3):1-82.

18. Pereira CA, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol. 2007 Aug;33(4):397-406.

19. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.

20. Ries AL. Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale. COPD 2005 Mar;2(1):105-10.

21. Langer D, Probst V, Pitta F, Burtin C, Hendriks E, Schans C et al. Clinical practice guideline for physical therapy in patients with Chronic Obstructive Pulmonary Disease (COPD): portuguese version. Rev Bras Fisioter. 2009 May-June;13(3):183-204.

22. Nakamura S, Kawakami M. Acute effect of use of the Flutter on expectoration of sputum in patients with chronic respiratory diseases. Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Feb;34(2):180- 5.

23. Bellone A, Lascioli R, Raschi S, Guzzi L, Adone R. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. Arch Phys Med Rehabil. 2000 May;81(5):558-60.

24. Lindemann H. The value of physical therapy with VRP 1-Desitin (“Flutter”). Pneumologie. 1992 Dec;46(12):626-30.

25. George RJ, Johnson MA, Pavia D, Agnew JE, Clarke SW, Geddes DM. Increase in mucociliary clearance in normal man induced by oral high frequency oscillation. Thorax. 1985 Jun;40(6):433-7.

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