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PEP DeviceIn positive expiratory pressure (PEP), a person breathes through a mask or a handheld mouthpiece. PEP devices allow air to flow freely as you breathe in, but not when you breathe out. You must breathe out harder against the resistance. It takes about four times as long to breathe out against the resistance than it does to breathe in. This helps air get behind the mucus and helps move it from lung and airway walls. It also holds your airways open, keeping them from closing.
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Oscillating PEP
Oscillating PEP is an airway clearance technique (ACT), where the person blows all the way out many times through a device. Commonly known by their brand names (Flutter®, Acapella®, AerobikA®, and RC-Cornet®), these types of oscillating PEP devices work in two ways. First, they use resistance to make it more difficult to breathe out, like non-oscillating PEP devices. Oscillating PEP devices also create vibrations when you breathe out. The vibrations move mucus from the surface of your airways. After blowing through the device several times, the person huff coughs to clear the mucus from the lungs and out of the body.
Although your respiratory therapist may suggest a different way to use PEP based on your unique circumstances, typically, people perform 10 breaths before stopping to cough or huff cough mucus out of their airways. A typical session of PEP takes about 20 minutes to complete.
Below you'll find information on how to use some of the common PEP devices.
Oscillating PEP is an airway clearance technique (ACT), where the person blows all the way out many times through a device. Commonly known by their brand names (Flutter®, Acapella®, AerobikA®, and RC-Cornet®), these types of oscillating PEP devices work in two ways. First, they use resistance to make it more difficult to breathe out, like non-oscillating PEP devices. Oscillating PEP devices also create vibrations when you breathe out. The vibrations move mucus from the surface of your airways. After blowing through the device several times, the person huff coughs to clear the mucus from the lungs and out of the body.
Although your respiratory therapist may suggest a different way to use PEP based on your unique circumstances, typically, people perform 10 breaths before stopping to cough or huff cough mucus out of their airways. A typical session of PEP takes about 20 minutes to complete.
Below you'll find information on how to use some of the common PEP devices.
Acapella
The Acapella Valve is a unique handheld device. It combines the benefits of positive expiratory pressure or PEP therapy with airway vibrations.
How it works:
Inside the valve is a small steel ball in a cone shaped valve. As you exhale, the ball moves up and down, doing two things:
Why’s that good?
The vibration opens up your airways, facilitating the movement of mucus. Exhaling against resistance creates back pressure or positive pressure which allows mucus to move from peripheral airways to the larger central airways so it can be coughed out.
How to use:
How it works:
Inside the valve is a small steel ball in a cone shaped valve. As you exhale, the ball moves up and down, doing two things:
- vibrating your airways and
- making you exhale against resistance.
Why’s that good?
The vibration opens up your airways, facilitating the movement of mucus. Exhaling against resistance creates back pressure or positive pressure which allows mucus to move from peripheral airways to the larger central airways so it can be coughed out.
How to use:
- Breathe in and out regularly through the valve 5 times.
- Then breathe in and out slowly 5 times. Your exhalations should be about 3 times longer than your inhalations.
- Keep alternating between regular and slow breathes.
- At the end of each exhalation, hold your breath 2 to 3 seconds.
- After 5 or 6 exhalations try to cough if you have not done so already. This will help get rid of mucus.
- Repeat until no further mucus is expelled. This should take between 10 and 20 minutes.
Aerobika
- Assure proper setting of the resistance indicator on the Aerobika. This is on the same side as the mouthpiece. Your health care provider will set the indicator when you get your Aerobika. Move the resistance indicator toward the + to increase resistance. Shift the indicator toward – to decrease resistance.
- Sit up with good posture to use the Aerobika. Sometimes we may have you lie in a postural drainage position to use the Aerobika. Postural drainage positions include lying flat on your back, and alternating right and left sides. Your health care provider will show you postural drainage positions to use if these are recommended.
- Place the Aerobika mouthpiece in your mouth. Seal your lips tightly around the mouthpiece.
- Take in a fairly deep breath and hold it for about 2-3 seconds.
- Exhale actively (but not too forcefully) through the mouthpiece until you no longer hear the flutter. Keep your cheeks as firm as possible when you exhale.
- Repeat this maneuver for 10-20 breaths. Try to resist coughing during this phase.
- Follow this cycle:
- 10-20 blows
- 2-3 huffs
- One big cough to bring the sputum up and out. Try not to swallow the mucus.
- Huff coughing is a type of coughing if you have trouble clearing your mucus. Take a breath that is slightly deeper than normal. Use your stomach muscles to make a series of 3 exhalations with the airway open, making a “ha, ha, ha” sound. Follow this by normal breathing and a deep cough if you feel mucus moving.
- Repeat cycle for 10-15 minutes 2 to 4 times a day (or as prescribed by your health care provider).
