Using a Positive Expiratory Pressure (PEP) Device

A positive expiratory pressure (PEP) device is a tool to help you breathe better. It helps people who have a lung condition keep healthy lung function. It helps clear mucus from your airways, expand your lung capacity, and prevent lung infections.

It may be used if you have certain conditions that affect the lungs, such as:

• Chronic obstructive pulmonary disease (COPD).
• Cystic fibrosis.
• Bronchiectasis.
• Asthma.

A PEP device helps you:

• Clear mucus. PEP devices help loosen and move mucus in the airways. This makes it easier to clear out excess mucus from your lungs.
• Expand the lungs. PEP therapy encourages deep breathing. This helps expand the tiny air sacs in the lungs, brings in more oxygen, and keeps your lungs elastic.
• Prevent infections. By clearing mucus, PEP devices reduce your risk of lung infections.

A PEP device is a portable tool. It has a mouthpiece or mask and a valve for exhaling. It may have a dial or settings to adjust the pressure. A PEP device creates positive pressure in the airways when you breathe out. This means you have to push air out of your lungs harder, against pressure. This helps keep the airways open and allows air to get behind the mucus when you breathe in. Having air behind the mucus can help move the mucus up toward your mouth so that you can cough it out. Some devices also vibrate when you breathe out. This helps loosen mucus so you can cough it out.

Your doctor, nurse, or physical or respiratory therapist can show you how to use this device.

Follow these instructions to use a PEP device:

1. Prep your PEP. Wash your hands with soap and water. Make sure your PEP device is clean and dry. Put the device together. Follow the instructions from the manufacturer.
2. Get in position. Sit upright or find a comfortable position that lets you breathe easily. Put the mouthpiece in your mouth securely. Or make sure the mask fits well over your mouth and nose.
3. Breathe in and out. Take a slightly larger than normal breath in through the device. Hold your breath for 2 to 3 seconds. Close your lips tightly around the mouthpiece. Or make sure the mask fits snugly. Breathe out through the device slightly stronger than normal for 3 to 4 seconds. Pause between breaths. If you feel dizzy, you may be breathing too fast.
4. Do set sessions. Do a series of controlled breaths out through the device, usually around 10 breaths each time, or as advised by your doctor, nurse, or therapist. Take short breaks between each set of breaths if you need to. Repeat the session 3 to 5 times a day, or as advised by your care team.
5. Huff and cough. You may be instructed to huff and cough after each set of 10 breaths. This is to move the mucus up in your lungs so you can cough it out.
   • First, remove the device from your mouth.
   • Take a slow, deep breath in. Hold your breath for 2 to 3 seconds.
   • Tilt your head slightly and breathe out, forcefully and slowly, through a wide-open mouth. Repeat this two more times. If you feel or hear mucus, cough to bring it up.
   • Spit the mucus into a tissue. Don't swallow it.
6. Adjust the pressure as needed. Some PEP devices have a dial or settings to adjust the resistance. Start with a lower pressure setting. Adjust the pressure as instructed by your care team or the device manufacturer.
7. Clean and maintain your device. After each use, clean the PEP device. Follow the manufacturer's instructions. Check it often for worn-out parts or filters. Replace them as needed.

Keep a record of your PEP therapy sessions to track your progress. Share it with your care team during check-ups.

If you feel too dizzy or have trouble breathing while using the PEP device, stop using it and talk with your doctor.