Thursday, April 4, 2019

PT Therapies: Positive Expiratory Pressure Therapy

Positive Expiratory Pressure (PEP) allows air to get behind the secretions to clear them.  A mask or mouthpiece with a one way breathing valve slows exhalation, allowing pressure to keep the airways open.  A manometer determines the correct level of PEP (10-20 cms of H2O pressure)

Breathing should be normal with slightly increased expiration.  Supplemental oxygen, or nebulized medication can be used at the same time as PEP.  Huffing or coughing is performed after use of the device.


  1. Equipment needed:
    1. PEP device with Mask or mouth piece
    2. Manometer (measuring device)
  2. Sit upright. Hold the mouth piece tightly between lips or hold the mask tightly against the face with both hands.
  3. Breathe in a normal sized breath.  Breathe out actively (but not forced) through the mask or mouthpiece.
    1. Adjust the resistance to expiration until the manometer measures 10-20cms of water pressure.
    2. When the proper resistance is reached, take 10 breaths through the PEP device at a normal rate.
    3. Exhalation should take about 3-4 seconds
  4. Perform 2-3 huffs or coughs to remove and mucus produces
  5. Pause and perform normal breathing using the lower chest with the upper chest and shoulders relaxed.
  6. Repeat the above procedure (#3-5) as needed.
  7. A treatment session should last about 20-30minutes.  The appropriate resistance of the device and the procedure used should be rechecked periodically during clinic visits or hospitilization.
Image result for pep device
PEP devices should be cleaned according to the manufacturer's directions or atleast washed regularly in hot, soapy water to avoid contamination.  The one-way valve should only be washed in hot water (no soap) to prevent the valve from sticking.

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