3 Ball Incentive Spirometer -- Exhalation mode?

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Swamp Thing
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I have watched a few videos about how to use a 3 ball incentive spirometer for lung rehabilitation. Most of them are about inhalation, which you exercise with the device held right side up.

I also saw a couple of videos where they hold the device upside down to test and strengthen exhalation rate. When I tried this, I found that it was impossible for me to get all 3 balls to the top. (Although I have recently recovered from Covid, I don't think I have residual respiratory problems -- I am researching this for someone else who had a more severe Covid infection)

So my question is -- are these devices really meant to be used upside-down in exhalation mode? (Unfortunately I can't find the videos where they demonstrate this).
 
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So this vendor, at least, doesn't recommend using the thing for exhalation exercises. Some youtubers are demonstrating that, which would perhaps be misleading at best and harmful at worst.
 
Swamp Thing said:
So this vendor, at least, doesn't recommend using the thing for exhalation exercises. Some youtubers are demonstrating that, which would perhaps be misleading at best and harmful at worst.
I only ever used a flow meter for FEV1 for regular monitoring, 6 monthly as part OH for work.
A 19980s/90s model, looks a little archaic now compared to a search on line today.

From memory it was very unpleasant, an unnatural force in my lungs to get the measurement and taking an average of three goes sometimes induced an attack.

I was not aware of the three ball model