Positive expiratory pressure

What is positive expiratory pressure?

Positive expiratory pressure (PEP) is a small handheld device fitted with either a mouth piece or mask. As you breathe, it gives out pressure at the end of each breath. This fills up the alveoli which is the part of the lungs where oxygen and carbon dioxide are exchanged. This pressure fills them up and stops them collapsing, so make breathing better.

To begin with, you may be given a manometer (a pressure gauge) with your PEP. This helps you to blow to an agreed pressure. As you get more used to blowing, most people find that they do not need the manometer any more. If this is the case, your physiotherapist will still check and review the pressure you are blowing when you visit clinic or are reviewed.

How does it work?

PEP works by allowing the user to blow against a pressure. This helps open up the airways allowing any sputum to move and be cleared.

Who can use it?

PEP is used for people with acute and chronic obstructive lung diseases. These include:

• cystic fibrosis
• chronic bronchitis
• tracheomalacia
• bronchomalacia (floppy airways)
• can also be used post-operatively

Your physiotherapist will advise you if they feel this treatment option is best for you.

When is PEP not the best treatment option?

PEP should not be used with people who have a collapsed lung or with an acute head injury.

It should be used with caution with:

• acute bronchospasm
• bullous disease
• surgical emphysema
• oesophageal anastomosis
• an unstable cardio-vascular state

If you know, or suspect, that you have any of these conditions, please tell your physiotherapist or person giving you a PEP.

Is it as effective as other treatments?

Yes it can be as effective as other treatments. If done correctly, PEP can be as effective as:

• the removal of sputum
• maintaining and improving lung function as percussion (‘patting’)
• other techniques

How do I use the PEP?

1. Make sure you have good posture. This makes sure the air can go around the most area of your lungs.
2. You should aim to blow at a pressure of cmH2O for seconds.
3. After you have done blows like this, have a big huff and cough to see if you can get rid of any fluids.
4. Now repeat this cycle times.

If you are feeling unwell or feel you still have fluids in your chest, you may want to do more cycles.

Your physiotherapist will show you how to adjust the coloured valve on your PEP so you know how to change it as your chest and lung function change.

When should I use it?

Your PEP should be used as instructed and will replace 1 or 2 of your daily physiotherapy sessions.

Some people prefer to use their PEP in the morning before school. Your physiotherapist will talk about the options with you.

If you take DNase, you should wait at least 30 to 45 minutes before having your physiotherapy.

Take any inhalers when you normally would during treatment.

If you take any nebulised antibiotics, take these after you have done your physiotherapy.

How do I clean it?

Your PEP should be cleaned every day in warm soapy water or more often if it looks dirty.

Split the PEP into its parts before you wash it. Leave it to air dry on a piece of paper towel.

Once a week you should boil your PEP in a saucepan of water or put it in the dishwasher.

Do not wash the manometer (pressure gauge) or tubing. If these become dirty you can wipe them with a damp cloth.