Positive Expiratory Pressure Therapy
Bottle PEP
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Campbell T. et al, (1986), The Use of a Simple Self-administered Method of Positive Expiratory Pressure (PEP) in Chest Physiotherapy after Abdominal Surgery, Physiotherapy, 72 (10), pp498-500.
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Santos M, Milroos M, McKenzie D, Alison J.(2017a) Bubble-positive expiratory pressure improve sputum clearance in people with bronchiectasis: a randomized crossover trial. Eur Respir J ; 50: PA2546
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Flutter & Acapella
AARC Clinical Practice Guideline: Use of Positive Airway Pressure Adjuncts to Bronchial Hygiene Therapy Respiratory Care. Respir Care. 1993; 38: 516-521.
Althaus P et al (1989). The Bronchial Hygiene Assisted by the Flutter VRP1 (Module Regulator of a Positive Pressure Oscillation on Expiration). Eur Resp J suppl 8; 2:693.
Althaus P (2009). Oscillating PEP – Flutter Therapy. In: McIlwaine M, Van Ginderdeuren F, Eds. Physiotherapy for people with Cystic Fibrosis throughout life: International Physiotherapy Group/Cystic Fibrosis 20-21
App EM, Kieselmann R, Reinhardt D, Lindemann H, Dasgupta B, King M, Brand P (1998). Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage. Chest Jul; 114(1):171-7.
Bradley JM, Moran FM, Elborn JS (2006). Evidence for Physical Therapies (Airway Clearance and Physical Training) in Cystic Fibrosis: an Overview of five Cochrane Systematic Reviews. Respir Med 100:191-201.
Brooks D, Newbold E, Kozar LF, Rivera M (2002). The flutter device and expiratory pressures. J Cardiopulm Rehabil Jan-Feb; 22(1):53-7.
Eaton T, Young P, Zeng I, Kolbe J (2007). A randomized evaluation of the acute efficacy, acceptability and tolerability of flutter and active cycle of breathing with and without postural drainage in noncystic fibrosis bronchiectasis. Chron Respir Dis 4(1):23-30.
Figueiredo PH, Zin WA, Guimaraes FS (2012). Flutter valve improves respiratory mechanics and sputum production in patients with bronchiectasis. Physiotherapy Research International 17(1):12-20.
Gondor M, Nixon PA, Mutich R, Rebovich P, Orenstein DM (1999). Comparison of Flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation. Pediatr Pulmonol. Oct; 28(4):255- 60.
Guimaraes FS, Moco VJ, Menezes SL, Dias CM, Salles RE, Lopes AJ (2012). Effects of ELTGOL and Flutter VRP1 on the dynamic and static pulmonary volumes and on the secretion clearance of patients with bronchiectasis. Revista Brasileira de Fisioterapia 16(2):108-13.
Homnick DN, Anderson K, Marks JH (1998). Comparison of the flutter device to standard chest physiotherapy in hospitalized patients with cystic fibrosis: A pilot study. Chest Oct; 114(4):993-7.
Konstan MW, Stern RC, Doershuk CF (1994). Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. J Pediatr 124(5 Pt 1):689–693.
Lagerkvist A, Sten GM, Redfors SB, Lindblad AG, Hjalmarson O (2006). Immediate changes in blood-gas tensions during chest physiotherapy with PEP and OscPEP in patients with CF. Resp Care 5:1154-1161.
Annemarie L Lee, Hannah C Williamson, Sarah Lorensin and Lissa M Spencer (2015). The effects of oscillating positive expiratory pressure therapy in adults with stable non-cystic fibrosis bronchiectasis: A systematic review. Chronic Respiratory Diseases 12(1):36-46.
McCarren B, Alison JA (2006). Physiological effects of vibration in subjects with CF. Eur Respir J 27:1204-1209.
McIlwaine PM, Wong LT, Peacock D, Davidson AG (2001). Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis. J Pediatr Jun; 38(6):845-50.
Morrison L, Agnew J (2009). Oscillating devices for airway clearance in people with cystic fibrosis. Cochrane Database of Systematic Reviews.(1):CD006842,
Murray MP, Pentland JL, Hill AT (2009). A randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasis. Eur Respir J Nov;34(5):1086-92.
Naraparaju S, Vaishali K, Venkatesan P, Acharya V (2012). A comparison of the Acapella and a threshold inspiratory muscle trainer for sputum clearance in bronchiectasis – A pilot study. Physiotherapy Theory & Practice 2696:353-7.
Newbold ME, Tullis E, Corey M, Ross B, Brooks D (2005). The flutter device versus the PEP mask in the treatment of adults with cystic fibrosis. Physiotherapy Canada 57(3):199-207.
Patterson JE, Bradley JM, Hewitt O, Bradbury I, Elborn S (2005). Airway clearance in bronchiectasis: a randomized crossover trial of Active Cycle of Breathing Techniques versus Acapella. Respiration 72(3):239-242.
Patterson JE, Hewitt O, Kent L, Bradbury I, Elborn JS, Bradley JM (2007). Acapella versus ‘usual airway clearance’ during acute exacerbation in bronchiectasis: a randomized crossover trial. Chronic respiratory Disease 4(2):67-74.
Pryor JA, Webber BA, Hodson ME, et al (1994). The Flutter VRP1 valve as an adjunct to chest physiotherapy in cystic fibrosis. Respir Med 88:677–81.
Pryor JA, Tannenbaum E, Scott SF, Burgess J, Cramer D, Gyi K, Hodson ME (2010). Beyond postural drainage and percussion: Airway clearance in people with cystic fibrosis. J Cystic Fibrosis 9(3):187-192
Tambascio J, de Sousa LT, Lisboa RM, Passarelli RdeC, de Souza HC, Gastaldi AC (2011). The influence of Flutter VRP1 components on mucus transport of patients with bronchiectasis. Respiratory Medicine 105(9):1316-21.
Thompson C S, Harrison S, Ashley J, Day K and Smith D L (2002). Randomised crossover study of the Flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis. Thorax 57;446-448
Valente AM, Gastaldi AC, Cravo SL, Afonso JL, Sologuren MJJ, Guimaraes AC (2004). The effect of two techniques on the characteristics and transport of sputum in patients with bronchiectasis: a pilot study. Physiotherapy 90(3):158-64.
Van Winden CM, Visser A, Hop W, Sterk PJ, Beckers S, de Jongste JC (1998). Effects of flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis. Eur Respir J Jul; 12(1):143-7.
Volsko TA, DiFiore J, Chatburn RL (2003). Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter. Respir Care Feb; 48(2):124-30.
West K, Wallen M, Follett J (2010). Acapella vs. PEP mask therapy: a randomised trial in children with cystic fibrosis during respiratory exacerbation. Physiother Theory Pract 26(3):143-9.
Mouthpiece and mask PEP
AARC Clinical Practice Guideline (1993): Use of Positive Airway Pressure Adjuncts to Bronchial Hygiene Therapy Respiratory Care. Respir Care 38: 516-521.
Christensen EF, Dahl R (1991). Treatment of chronic bronchitis with terbutaline inhaled from a cone spacer with and without positive expiratory pressure. Lung 169(6):325-33.
Christensen EF, Nedergard T, Dahl R (1990). Long-term treatment of chronic bronchitis with positive expiratory pressure mask and chest physiotherapy. Chest 97(3):645-50.
Cortina-Herrero B, Vilaro J, Marti D, Torres A, San Miguel-Pagola M, Alcaraz V, Polverino E (2016). Short term effects of slow expiratory airway clearance techniques in patients with bronchiectasis. A randomised crossover trial. Physiotherapy; 102(4): 357-364.
Darbee JC, Kanga JF, Ohtake PJ (2005). Physiologic evidence for HFCWO & PEP breathing in hospitalized subjects with CF. Physical Therapy 85:1278-1289
Darbee JC, Ohtake PJ, Grant BJ et al (2004). Physiologic evidence for the efficacy of positive expiratory pressure as an airway clearance technique in patients with cystic fibrosis. Phys Ther 84:524-37.
Elkins M, Jones A, van der Schans C (2006). Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. The Cochrane Database of Systematic Reviews Issue 2. CD003147.
Fagevik Olsen M, Lannefors L, Westerdahl E (2015). Positive expiratory pressure: common clinical applications and physiological effects. Respiratory Medicine; 109(3): 297-307.
Falk M, Kelstrup M, Andersen JB et al (1984). Improving the Ketchup Bottle Method with Positive Expiratory Pressure, PEP, in Cystic Fibrosis. Eur J Respir Dis 65:423-432.
Groth S, Stavanger G, Dirksen H, Andersen JB, Falk M, Kelstrup M (1985). Positive Expiratory Pressure (PEP-mask) Physiotherapy improves Ventilation and reduces Volume of Trapped Gas in Cystic Fibrosis. Clin Respir Physiol 21:339-343.
Hofmeyr JL, Webber BA, Hodson ME (1986). Evaluation of Positive Expiratory Pressure as an Adjunct to Chest Physiotherapy in the Treatment of Cystic Fibrosis. Thorax 41; 951 954.
Lannefors L, Eriksson L (2009). Positive Expiratory Pressure (PEP). In: McIlwaine M, Van Ginderdeuren F, Eds. Physiotherapy for people with Cystic Fibrosis throughout life: International Physiotherapy Group/Cystic Fibrosis 12-13.
Lannefors L, Button BM, McIlwaine M (2004). Physiotherapy in infants and young children with cystic fibrosis: current practice and future developments. J of the Royal Society of Medicine Suppl 44: Vol 97: 8-24.
Lannefors L, Wollmer P (1992). Mucus Clearance with Three Chest Physiotherapy Regimens in Cystic Fibrosis: a Comparison between Postural Drainage, PEP and Physical Exercise. Eur Resp J 5:748-753.
Lee AL, Burge AT, Holland AE (2017) Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis. Cochrane Database of Systematic Reviews; Issue 9, CD: 011699.
Lee AL, Denehy L, Wilson JW, Stirling RG, Heine RG, Button BM (2012). Upright positive expiratory pressure therapy and exercise: effects on gastroesophageal reflux in COPD and bronchiectasis. Respiratory Care 57(9):1460-7.
McIlwaine PM, Wong LT, Peacock D, Davidson AG (1997). Long-term comparative trial of conventional postural drainage and percussion versus positive expiratory pressure physiotherapy in the treatment of cystic fibrosis. J Pediatr Oct; 131(4): 570-4.
McIlwaine PM, Wong LT, Peacock D, Davidson AG (2001). Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis. J Pediatr Jun; 138(6): 845-50.
McIlwaine MP; Alarie N; Davidson GF; Lands LC; Ratjen F; Milner R; Owen B; Agnew JL (2013). Long-term multicentre randomised controlled study of high frequency chest wall oscillation versus positive expiratory pressure mask in cystic fibrosis. Thorax 68(8):746-51, 2013
McIlwaine M, Button B, Dwan K (2015) Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis (Review). The Cochrane Collaboration. The Cochrane Library Issue 6.
Mortensen J, Falk M, Groth S, Jensen C (1991). The Effects of Postural Drainage and Positive Expiratory Pressure Physiotherapy on Tracheobronchial Clearance in Cystic Fibrosis. Chest 100:1350-1357.
Newbold M, Tullis E, Corey M, Ross B, Brooks D (2005). The flutter device versus the PEP mask in the treatment of adults with cystic fibrosis. Physiotherapy Canada 57(3): 199-207.
Osadnik CR; McDonald CF; Miller BR; Hill CJ; Tarrant B; Steward R; Chao C; Stodden N; Oliveira CC; Gagliardi N; Holland AE (2014). The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial. Thorax 69(2):137-43.
Pryor JA, Tannenbaum E, Scott SF, Burgess J Cramer D, Gyi K, Hodson ME (2010) Beyond postural drainage and percussion: Airway clearance in people with cystic fibrosis. Journal of Cystic Fibrosis. 9(3): 187-92
Pryor JA, Webber BA, Hodson ME, Warner JO (1994). The Flutter VRP1 as an Adjunct to Chest Physiotherapy in Cystic Fibrosis. Respiratory Medicine 88; 677 681
Sirithangkul S, Ranganathan S, Robinson PJ, Robertson CF (2010). Positive expiratory pressure to enhance cough effectiveness in tracheomalacia. J Med Assoc Thai Nov;93 Suppl 6:S112-8.
Steen IU, Redmond AOB, O´Neill D, Beattie F (1991). Evaluation of the PEP Mask in Cystic Fibrosis. Acta Paediatr Scand 80:51-56.
Suggett J, Costa R, Meyer A, Patel J (2022). Assessment of Two Oscillating Positive Expiratory Pressure (Opep) Devices: How Do the Differing Mechanisms of Action Impact Lab Performance. Thorax Nov 2022:77 (Supp 1).
TØnnesen P, StØvring S (1984). Positive Expiratory Pressure (PEP) as Lung Physiotherapy in Cystic Fibrosis Eur J Respir Dis 65:419-422.
Van Asperen PP, Jackson I, Hennesey P, Brown J (1987) Comparison of Positive Expiratory Pressure (PEP) Mask with Postural Drainage in Patients with Cystic Fibrosis. Aust Paed J 23:283-284.
Van Winden CM, Visser A, Hop W, Sterk PJ, Beckers S, de Jongste JC (1998). Effects of flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis. Eur Respir J 12(1):143-7
West K, Wallen M, Follett J (2010). Acapella vs. PEP mask therapy: a randomised trial in children with cystic fibrosis during respiratory exacerbation. Physiother Theory Pract 26(3):143-9
