The Flutter®

This page explains about the Flutter® and what to expect when your child comes to Great Ormond Street Hospital (GOSH). The Flutter® is part of the treatment to help people who have difficulty clearing sputum (phlegm) from their lungs.

Flutter (procedures and treatments)

The equipment consists of a pipe-shaped device made up of four parts: a mouth piece, a semicircular cone, a steel ball and a perforated cover.

Assembling the Flutter®

The Flutter® is easily assembled by piecing it together as seen in the photograph.

How does the Flutter® work?

When you breathe out through the Flutter® pressure builds up in your lungs. This helps to keep the airways open wide and also allows air to get behind sputum and help move it upwards. The vibrations transmitted through the chest wall by the action of the steel ball also help to loosen sputum from the sides of the airways.

Using the Flutter®

Your physiotherapist will show you how to use the Flutter®. This guide is a reminder for you.

  1. Treatment can be carried out in sitting or any postural drainage position (where possible).
  2. Relax your stomach muscles and take a few normal breaths before using the Flutter®.

  3. Close your lips around the mouthpiece of the Flutter®, making sure there is a good seal.

  4. Take a slightly bigger than normal breath in through your nose and then breath out through the Flutter®. You may feel vibrations on your chest wall.

  5. Repeat eight to ten times.

  6. Following this, you should put the Flutter® down and do huffing and coughing to clear any sputum. You should then have a period of relaxed breathing before continuing.

This cycle should continue for 15 to 20 minutes or until you have cleared all your sputum.

You can alter the angle of the Flutter® to make it slightly more difficult. A huff can also be performed into the Flutter® to help mobilise sticky secretions.

Risks of using the Flutter®

As with all airway clearance devices it is very important that equipment is kept clean to prevent infection.

There have been no reported problems with the use of the Flutter® or any other airway clearance techniques. However, if you are worried about your child's chest, especially if they become short of breath, have chest pain or are coughing up blood, it is important that you contact the Cystic fibrosis team at GOSH without delay.

Cleaning the Flutter®

The Flutter® should be taken apart, cleaned in hot soapy water and dried thoroughly every day.

Take care when taking apart or putting together the Flutter® as it may crack if it is dropped on a hard surface.


You should sterilise the Flutter® at least once a week using a steam steriliser or putting it in a clean bowl of boiling water. Do not use a microwave steriliser.


Do not store the Flutter® on a windowsill or in direct sunlight. When it is dry, you should either wrap it in a lint-free cloth, place it in the bag provided or put it in a clean plastic container with a lid and keep it in a dust-free environment.

Compiled by:
Physiotherapy department in collaboration with the Child and Family Information Group This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals.
Last review date:
September 2017