If you find it difficult to clear sputum (phlegm) from your lungs, you might use a Flutter® as part of your treatment at Great Ormond Street Hospital (GOSH).

What is the Flutter®?

Flutter (procedures and treatments)

The Flutter® is a pipe-shaped device made up of four parts:

  • a mouth piece
  • a semicircular cone
  • a steel ball 
  • a perforated cover
It’s easy to assemble by piecing it together, as shown in the photograph.

How it works

When you breathe out through the Flutter® pressure builds up in your lungs. This helps to keep your 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.

  • Sit down or move into any postural drainage position (where possible).
  • Relax your stomach muscles and take a few normal breaths before using the Flutter®.
  • Close your lips around the mouthpiece of the Flutter®, making sure there is a good seal.
  • 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.
  • Repeat eight to 10 times.
  • After 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.


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. But if you are worried about your chest, especially if you become short of breath, have chest pain or are coughing up blood, it’s important that you tell an adult and contact the Cystic Fibrosis team at GOSH immediately.


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

Take care when you take it apart or put it together. The Flutter® may crack if it’s dropped on a hard surface.


You should sterilise the Flutter® at least once a week using a steam steriliser or by 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’s 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:
Great Ormond Street Hospital
Last review date:
July 2014