Positive expiratory pressure devices

These devices can be used on their own, or at the same time as other breathing exercises such as Autogenic Drainage. 

Devices include:

  • Positive Expiratory Pressure mouthpiece.
  • Positive Expiratory Pressure mask.
  • Oscillatory Positive Expiratory Pressure, for example Flutter, Acapella, Aerobika.
  • They are used when the patient/client  finds the Active Cycle of Breathing Technique or Autogenic Drainage is not effective or is making them wheezy or cough a lot.
  • If they regularly produce a lot of sputum.
  • If sputum is very sticky despite good hydration.

Blowing into a positive pressure device creates a small positive pressure in the airways which helps to hold the airways open (limiting wheeze and airway closure) and allow sputum to move more easily to the central airways where it can be coughed up.

The following film shows one of these devices called Acapella.

View text transcript

We are now going to show you a short clip using a device called an Acapella. This is an oscillatory device which helps to clear secretions. What we are going to do first of all. I have set the dial to three, so that is your resistance and you will need to take a slightly bigger than normal breath in.


Put your lips around the mouthpiece and blow out through the machine. When you do that the machine will vibrate the air into your airways and loosen off the secretions.

We are going to do five breaths with the Acapella. Once you have done your five breaths we will go on to your huff. This is a medium sized breath in and you breathe out as if you are steaming up your mirror. You may hear the secretions moving. Keep huffing until you feel the urge to cough to clear the secretions.

Take five slightly bigger than normal breaths in. Blow into the Acapella machine.

Have a few normal relaxed breaths and repeat the five breaths and Acapella again. Some relaxed breaths followed by your huffing until you feel the urge to cough.