Vibratory PEP Device and Hospital Length of Stay for Acute Exacerbation of COPD

The investigators hypothesize that the PEP-FV used as adjunctive therapy in patients
hospitalized for an acute exacerbation of COPD will result in decreased hospital length of
stay and improvement of overall COPD-related health outcomes.

Inclusion Criteria:

- Admitted with COPD exacerbation as a primary diagnosis

- Subjectively produces more than 1 tablespoon (15 ml) / day of sputum

- Has the subjective feeling that he/she cannot cough up or clear her secretions

- Physical respiratory system exam by the physician with evidence of course ronchi
suggestive of impacted secretions

- > 10 pack-year smoking history

Exclusion Criteria:

- Cannot use the flutter device or unable to follow commands

- Altered mental status

- Known active malignancy

- Known systolic congestive heart failure (CHF) with ejection fraction (EF) < 40% or
clinically in acute CHF exacerbation as documented by cardiologist or primary
diagnosis other than COPD

- Pregnancy

- Patients in severe exacerbation (Intubated, Continuous use of NIPPV, Unable to speak
full sentences)

- Intracranial pressure (ICP) >20 mmHg

- Hemodynamic instability (requiring vasopressor support)

- Recent facial, oral, or skull surgery or trauma.

- Acute sinusitis.

- Epistaxis.

- Esophageal surgery.

- Active Hemoptysis (More than 2 tablespoons of frank blood per day)

- Nausea.

- Severe earache or discharge from ear. (Known or suspected tympanic membrane rupture or
other middle ear pathology)

- Untreated pneumothorax.