Lindsay Shaw

Oscillating PEP

Oscillating positive expiratory pressure (PEP) combines the techniques of PEP with high-frequency oscillations at the airway opening. Flutter valve device is the original oscillating PEP, developed in Switzerland in the late 1980s. Oscillating PEP generates oscillations of about 15Hz, which are transmitted through the airways. The interruption in the airflow with the oscillation helps to loosen the mucus and move it to the upper airways. By gently breathing out through an oscillating PEP device, a positive pressure of 18-22cm of water back pressure is created, which helps mobilize the mucus in the airways. A more forceful breath out through the device creates as much as 35cm of water back pressure; and this facilitates the removal of airway mucus. Holding one's breath for about 3 seconds after breathing in is recommended to allow air to be pushed behind the mucus and promote movement of the secretions.

Existing oscillating PEP devices include the following. Click the available links for detailed cleaning instructions.

(1) Flutter®

(2) acapella®, acapella® choice, acapella® duet

(3) RC Cornet®

(4) Quake®

Oscillating PEP has been shown to be a valid alternative to conventional chest physiotherapy; and it has been found to be as effective as other airway clearance techniques. However, in situations where an individual feels very short of breath, is diagnosed with pneumothorax, or is coughing up large amount of blood (hemoptysis) it may not be appropriate to use the oscillating PEP device. You should contact the physiotherapist on the CF team for an assessment and advice.

Note that proper cleaning of the oscillating PEP device after each use and disinfecting the device regularly are vital. Please read and follow the recommended cleaning instructions for each product, see above links.