Positive Expiratory Pressure (PEP)

Please speak to a physiotherapist or your CF medical team before commencing any new treatment. DO NOT start using a device, or technique, on this website if you have not discussed this with your CF team first.  

Positive expiratory pressure (PEP) therapy involves breathing against a resistance as you breathe out. This can assist in the removal of mucus and opening areas of your lungs that are partly blocked by mucus. You can learn more about how this works in the “understanding how air moves in your airways” section. A PEP device is made up of a few parts: Components of a PEP device include:

• A mask or mouthpiece
• A resistor
• A one-way valve – this allows you to breathe in (inhale) through the device but closes when you exhale so that you breathe out via the resistor

How does PEP help?

• It splints (hold open) the airways open
• Increases lung volumes (amount of air in the lungs) and increases air to clogged airways
• It builds up the amount of air behind mucus

How do I do PEP?

• Seek assistance from an experienced physiotherapist when performing PEP for the first time

• Get into a comfortable position with your back straight. If you are sitting up you should ideally be leaning slightly forwards onto a table with your elbows supported (not slumped)
• Take slightly bigger than your usual resting breath in and out through the PEP device
• Your breath out should be a slightly active (forced, but not too forced) breath out against the resistor
• Perform 10-15 breaths in a row maintaining a sealed mask or sealed lips (with all the breathing occurring in and out of the mouthpiece). To ensure good mouthpiece PEP technique your physiotherapist may encourage you to use a nose clip
• The best resistance for you is usually chosen by a combination of your feedback and pressure measurements by a physiotherapist – you should seek assistance from your CF clinic physiotherapist when starting with PEP, and your technique should be regularly reviewed
• When secretions have reached the upper airways use huffing and controlled coughing to remove secretions from your lungs

Are there different types of PEP devices?

There are many different PEP devices that are currently recommended by Australian and New Zealand Physiotherapists. These are:

1.AstraTech® PEP

Please speak to a physiotherapist or your CF medical team before commencing any new treatment. DO NOT start using a device, or technique, on this website if you have not discussed this with your CF team first.  

This device consists of a:

• Face mask (silicone)
• Eight coloured resistors ranging from 1.5 – 5mm in 0.5 mm steps
• It can be purchased with a manometer (pressure gauge) or pressure gauge for checking PEP pressures
• It cannot be combined with a nebuliser bowl