PEP

Airway Clearance Therapy

Airway Clearance Therapy is a fundamental component in managing respiratory conditions characterized by mucus production and obstruction. This therapy is particularly relevant in conditions such as Cystic Fibrosis (CF), bronchiectasis, and emphysema, which often lead to mucus accumulation and respiratory infections (e.g., pneumonia).

Key Topics

  • Mucus Clearance Therapy

    • Conditions Treated:

    • Cystic Fibrosis (CF)

    • Bronchiectasis

    • Pneumonia

Positive Expiratory Pressure (PEP) Therapy

  • Definition: A technique involving exhaling against resistance to help clear mucus from the airways.

  • Indications:

    • Chronic Obstructive Pulmonary Disease (COPD)

    • Asthma

    • Atelectasis with mucus

  • Mechanism of Action:

    • The patient exhales against resistance, which splints the airways open and mobilizes mucus.

  • Performance Instructions:

    • Position: Patient seated with elbows on a table.

    • Equipment Required:

      • Mask or mouthpiece

      • T-assembly with a one-way valve

      • Orifice resistors

      • Manometer

  • Breathing Technique:

    • Diaphragmatic breathing is encouraged to inspire large tidal volumes (VT) without reaching total lung capacity.

  • Targets:

    • Aim to achieve 10-20 cmH20 during exhalation.

    • Perform 10-20 breaths followed by 4-6 huff coughs.

    • Duration: 10-20 minutes per session, 1-4 times a day.

  • Contraindications:

    • Hemoptysis (coughing up blood)

    • Pneumothorax (collapsed lung)

Oscillatory (Vibrating) PEP Therapy

  • Advantages:

    • Decreases the viscoelastic properties of mucus, making it easier to mobilize.

    • Generates bursts of increased expiratory airflow.

  • Types of Oscillatory PEP Devices:

    1. Flutter

      • A pipe-shaped device containing a steel ball that uses gravity to produce oscillations at approximately 10 cm H20.

    2. Acepella

      • Utilizes a counterweighted plug and magnet to create airflow oscillation during expiratory flow.

    3. Quake

      • A manually operated device with a rotating handle to control oscillation speed and frequency.

    4. Aerobika

      • Offers 5 settings for resistance; recommended ratio of assistive pressure 1:3 or 1:4 for a duration of 10-20 minutes.