Leila Cruikshank

Positive Expiratory Pressure (PEP)

Positive expiratory pressure (or commonly known as PEP mask) was developed in Denmark in the late 1970s as an alternative airway clearance technique. During exhalation through the PEP device, resistance is created and adjusted to produce 10-20cm of water back pressure. This is similar to breathing out through a straw while blocking the nose. The PEP device is available with either a face mask or mouthpiece option. Breathing out should take three to four times as long as breathing in. This prolonged breathing out against positive pressure allows deeper airways to be stabilized while air is pushed behind the mucus. The mucus is ultimately pushed to the upper airways, which can be cleared by coughing or huffing. It will also help equalize the air going into different portions of the lung and thus improve the amount of air getting into the body.

Currently, there are three PEP devices available on the market:

(1) Astra Tech-PEP/RMT

(2) TheraPEP®

(3) PariPEP™S

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 PEP device. You should contact the physiotherapist on the CF team for an assessment and advice.

Note that proper cleaning of the PEP device after each use and disinfecting the device regularly are vital. Please read and follow the recommended cleaning instructions.