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

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.