Mouthpiece PEP can be combined with inhaled hypertonic saline, or normal saline. It should never be combined with inhaled antibiotics or pulmozyme.
Using combination therapy may be a useful option to help with adherence, to get both treatments done in one session.
The client is encouraged to take breaks during the nebuliser therapy to huff and clear secretions. They may also need to take a break with some gentle relaxed breathing between sets.