A patient uses the Flutter by inserting the mouthpiece but keeping it horizontal. The amount of tilt is important. Then, the patient takes a deep breath in and holds it up to three seconds, before releasing the breath into the device. The device has an adjustment dial so the patient may feel the most vibrations. The cone is where the patient feels the vibrations. Generally, the adjustments are at 5 - 20 cm H2O. The patient repeats this with up to twelve breaths followed by two "huffs", coughing to remove the unwanted mucous. Each patient will have a different amount of time to perform this procedure. Average amount of time is three to six times. The important thing to remember: stop when no more mucous comes out. The entire process can take up to an hour to complete.