The Acapella device is a handheld tool that helps you clear mucus from your lungs by creating vibrations and back-pressure as you exhale through it. The basic technique involves breathing in deeply, holding for about 3 seconds, then exhaling slowly through the mouthpiece while keeping your cheeks firm. Most people repeat this cycle for 10 to 20 breaths per session, followed by a controlled cough to bring up loosened mucus.
How the Device Works
Inside the Acapella, a counterweighted plug and magnet create resistance that interrupts your airflow in rapid pulses as you breathe out. This does two things simultaneously. First, the positive pressure keeps your airways propped open so air can get behind and underneath trapped mucus. Second, the rapid oscillations create tiny vibrations that travel down into your lungs, thinning sticky secretions and shearing them off the airway walls. Once the mucus is loosened and mobilized toward your larger airways, a cough or huff brings it up.
Think of it like shaking a ketchup bottle: the vibrations reduce how thick and sticky the mucus is, making it much easier to move. The resistance dial on the device lets you adjust how strong those vibrations feel, so you can find a setting that’s comfortable but effective.
Choosing the Right Model
Acapella devices come in two main color-coded versions based on how strongly you can exhale. The green model is designed for people who can sustain an exhale above 15 liters per minute for at least 3 seconds, which covers most adults with moderate lung function. The blue model is for people whose expiratory flow falls below 15 liters per minute, typically those with more severe obstruction or weakness. If you’re unsure which one fits you, your respiratory therapist or physiotherapist can test your flow and recommend the correct device.
Step-by-Step Instructions
Sit upright in a comfortable chair with your feet flat on the floor. Good posture helps your lungs expand fully and makes the therapy more effective. If you use a nebulizer with bronchodilator medication, do that first so your airways are as open as possible before you start.
Set the resistance dial to a low or medium setting to begin. You can increase it over time as you get comfortable with the technique. Place the mouthpiece in your mouth and create a good seal with your lips.
The Breathing Cycle
Take a fairly deep breath in through your nose (not through the device) and hold it for about 3 seconds. This pause lets air distribute evenly throughout your lungs, including behind pockets of mucus. Then exhale as much as possible through the mouthpiece, but not forcefully. The exhale should be slow and controlled, lasting about 3 to 4 seconds. You’ll feel a fluttering vibration in your chest as you breathe out. Keep your cheeks as firm as possible during the exhale rather than letting them puff out, since bulging cheeks absorb the vibrations before they reach your lungs.
Repeat this inhale-hold-exhale cycle for 10 to 20 breaths. After that set, remove the mouthpiece and perform two or three huff coughs to clear whatever mucus has moved up into your larger airways.
How to Huff Cough
A huff cough is gentler and often more effective than a regular hard cough. Take a breath slightly deeper than normal, then use your stomach muscles to push out three quick exhalations with your throat open, making a “ha, ha, ha” sound. It should feel like you’re fogging up a mirror. Follow this with relaxed normal breathing and then a deep cough if you feel mucus ready to come up. Spit out any mucus into a tissue.
Most people do two to four rounds of the full cycle (10 to 20 breaths plus huff coughing) per treatment session, spending roughly 15 to 20 minutes total. Your therapist may adjust this based on how much mucus you typically produce.
Adjusting the Resistance Dial
The numbered dial on the device controls how much resistance you feel and how strong the vibrations are. A lower number means less resistance, which is easier if you have limited lung function or are just starting out. A higher number increases the vibration intensity. The goal is to find a setting where you can comfortably exhale for 3 to 4 seconds and feel distinct fluttering in your chest without straining or running out of breath too quickly. If you can barely get air through the device, dial it down. If you feel no vibration at all, turn it up.
Cleaning and Maintenance
Clean your Acapella every day after use. Disassemble the device into its separate parts, soak them in warm water with liquid dish detergent, then rinse with clean water and let everything air dry on a clean towel. Do not reassemble the device while parts are still damp, since moisture trapped inside encourages bacterial growth.
Once a week, do a deeper disinfection. Soak the parts in 70% isopropyl alcohol for 5 minutes, or in 3% hydrogen peroxide for 30 minutes. Rinse thoroughly and air dry. Note that cleaning instructions vary slightly between models. The Acapella Choice, for example, should not be placed in a dishwasher, boiled, or cleaned with bleach. Always check the instructions that came with your specific device.
Plan to replace the device about once a year, or sooner if you notice the vibrations weakening, the parts becoming difficult to clean, or any visible wear or cracking. Your physiotherapist can help you determine when a replacement is needed.
Who Should Avoid Using It
The three main adverse effects reported with oscillating positive expiratory pressure devices are coughing up blood (the most common), collapsed lung (pneumothorax), and airway spasm. People with an untreated collapsed lung, recent chest or abdominal surgery, unstable heart conditions, active rib fractures, or uncontrolled coughing of blood should not use the Acapella without direct medical clearance. Conditions that raise pressure inside the skull are also a concern, since the forced exhale increases pressure in the chest.
If you experience sharp chest pain, notice blood in your mucus for the first time, or feel significantly more short of breath during a session, stop the treatment and contact your care team.
Tips for Getting the Most Out of Each Session
- Stay hydrated. Drinking water throughout the day helps keep mucus thinner, which makes the device’s vibrations more effective at loosening it.
- Be consistent. Using the device once or twice daily on a regular schedule clears mucus more effectively than occasional use.
- Don’t rush the exhale. A slow, steady breath out lets the vibrations work longer. Blasting air through the device quickly reduces the time the oscillations can act on your secretions.
- Use it before meals or at least an hour after eating. The coughing at the end of a session can trigger nausea on a full stomach.
- Pair it with other treatments in the right order. If you use an inhaled bronchodilator, take it before the Acapella session. If you use inhaled antibiotics or steroids, use those after clearing mucus so the medication can reach cleaner airways.