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Pep Therapy

Medically reviewed by Last updated on Jan 5, 2023.

What is PEP therapy?

PEP (positive expiratory pressure) therapy helps open and move mucus out of your lungs. You breathe into a small handheld device that has a valve. You breathe out against a set amount of pressure. The pressure helps hold your airways open. It also allows air to get behind and loosen mucus. The air moves mucus so you are able to cough it up and out. Some PEP therapy devices use vibrations, or oscillations, to help loosen mucus. As you breathe out, the pressure and vibrations in your airways work together to help loosen mucus. PEP therapy also helps air get into the small airways deep in your lungs. Mucus can collect in your small airways and become infected if it is not cleared.

What steps do I need to follow for PEP therapy?

Your healthcare provider will set your device to the amount of pressure needed. Your provider will tell you to repeat these steps at least 5 times to make 1 cycle. Repeat the following steps as many times as directed to complete 1 cycle:

  • Loosen mucus:
    • Sit up with your back straight and your chin slightly up. This position allows your throat to be open so air can move easily without blockage.
    • You may need to put your elbows on a table. This may keep you from slouching and blocking air from moving freely.
    • Take a deep breath and hold it for 2 to 3 seconds.
    • While you hold your breath, place the mouthpiece in your mouth or the mask over your mouth and nose.
    • Breathe out at a steady rate for 4 to 6 seconds or as long as you can. Keep your cheeks as flat as possible. You may have to use your fingers to hold your cheeks down. Try not to cough.
    • You may be able to keep the mouthpiece in, or your mask on, as you repeat. Take a deep breath in through your nose.
  • Cough and bring up mucus:
    • Remove the mouthpiece from your mouth or the mask from your face.
    • Do 2 to 3 huff coughs. Take a deep breath in. Use your stomach muscles to breathe out 3 quick, forceful breaths. Make a ha, ha, ha sound.
    • Then cough hard to bring up mucus. Spit the mucus out. Do not swallow the mucus.
    • You may need to rest for 1 to 2 minutes.
    • Repeat the cycle for up to 30 minutes.

How do I clean my PEP device?

Clean mucus and moisture out of your device after every use. A more complete cleaning depends on the type of device you use. Ask your healthcare provider for information on cleaning your specific device. Never use bleach to clean any device.

When should I call my doctor?

  • You are not able to move mucus after several cycles.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.