Positive expiratory pressure is used in patients breathing spontaneously as continuous positive airway pressure mostly applied by mask. The С PAP is used in the treatment of respiratory failure and in conditions with impaired clearing of airway secretions, for example, after abdominal surgery.
The CPAP is not suitable for home treatments because of the high airflow needed. A simplified positive expiratory pressure system has been developed as a PEP mask (Fig 1). This system is more convenient for self administration and home treatment. It consists of a facemask connected to a T-tube where inspiratory and expiratory airflow are separated by a valve. Variable expiratory resistances can be applied onto the expiratory tube as connections of different diameters, causing positive airway pressure only during expiration.
The use of PEP-mask has been studied in patients with cystic fibrosis with conflicting results concerning clearing of secretions from the airways and improvement of arterial oxygen saturation compared to conventional chest physiotherapy, ie, postural drainage, percussion, and forced expirations and breathing exercises.
FIGURE 1. PEP mask is a face mask connected to a T-tube where inspiratory and expiratory airflow are separated by a valve. Variable expiratory resistances can be applied onto the expiratory tube as connections of different diameters. In this way, a positive airway pressure is created during expiration. The pressure can be controlled by a manometer.
In a recent study, the use of PEP-mask was shown to be comparable to CPAP in prevention of pulmonary complications after abdominal surgery. cialis professional
Chest physiotherapy is used also in chronic bronchitis. Its main indication seems to be acute exacerbations of chronic bronchitis with increased mucus production, whereas the value of regular chest physiotherapy during chronic phases is uncertain. However, the effect of long-term treatment with chest physiotherapy combined with PEP has not been studied. The purpose of this study was to compare the prophylactic effect of diaphragmatic breathing and forced expirations with and without PEP-mask in the
home treatment of patients with chronic bronchitis. The effect was evaluated with respect to symptoms, number of acute exacerbations, number of sick-leaves, need for additional medication (including antibiotics), and by lung function tests.