At the same time, the pulses (or oscillations) create vibrations within the airways helping to thin and shake loose mucus that may be too thick or sticky for the pressure alone to move. The combination of oscillations and pressure aids in moving mucus into the central airways, where it can be coughed out.
Use Active Exhalation
Active exhalation can best be described as the type of effort required to start blowing up a balloon — but is not as forceful as blowing out candles. Keep your cheeks flat as you exhale.
Try a ' Huff Cough'
A ‘huff cough’ will help move mucus up and out of your lungs. Just like when you use your breath to create fog on a mirror, you would take a short, shallow breath and exhale forcefully with your mouth in an ‘O’ shape. Contact your healthcare professional if you need help with the proper technique.
- CLOSE LIPS around mouthpiece
- INHALE and HOLD 2–3 seconds
- EXHALE — slowly, steady, firmly
- REPEAT and cough as needed
NOTE: If at any time during use your device does not oscillate upon exhalation, it can be reset by moving the resistance indicator and returning to its original position. If required, carefully take the device apart as instructed and inspect for damage or foreign objects. Once the device is clear of any issue, reassemble and use as per the operating instructions. Please ensure the cleaning instructions are followed as recommended.
The Importance of Distilled Water
Distilled water is purified water that has gone through a rigorous process to strip it not only of contaminants, but also naturally occurring minerals. Distillation involves boiling the water and then condensing the steam into a clean container. Distilled water is not the same as purified, filtered or bottled water. It is sold at most major retailers at a cost comparable to other bottled waters. Distilled water is recommended because other types of water can contain minerals and calcium. Over time, these minerals can deposit on components within the device causing an adverse effect on device performance.
How to Use with a nebulizer treatment
If you are unable to do the treatment for 20 minutes, move the indicator one notch to the right towards the ‘-‘ symbol. If it feels too easy and after 20 minutes you cannot feel any mucus ready to cough out, then dial it to the left one notch towards the ‘+’ symbol.
Impact of mucus
Impact of Aerobika* OPEP
A quick and easy overview explaining oscillating PEP therapy and how to use the Aerobika* Oscillating PEP device.
A short video using animation of a lung to help explain and understand the function of an oscillatory PEP device.
1 Prescott, E., P. Lange, and J. Vestbo. “Chronic mucus hypersecretion in COPD and death from pulmonary infection.” European Respiratory Journal 8.8 (1995): 1333-1338. 2 Burgel, P. R., and C. Martin. “Mucus hypersecretion in COPD: should we only rely on symptoms?.” European Respiratory Review 19.116 (2010): 94-96. 3 Tesfaigzi, Yohannes, Paula Meek, and Suzanne Lareau. “Exacerbations of chronic obstructive pulmonary disease and chronic mucus hypersecretion.” Clinical and Applied Immunology Reviews 6.1 (2006): 21-36. 4 Groenewegen, Karin H., and Emiel FM Wouters. “Bacterial infections in patients requiring admission for an acute exacerbation of COPD; a 1-year prospective study.” Respiratory medicine 97.7 (2003): 770-777. 5 Svenningsen S, Paulin G, Sheikh K, Pike D, Etemad-Rezai R, Suggett J, McCormack DG and Parraga G. Oscillating Positive Expiratory Pressure Therapy in Chronic Obstructive Pulmonary Disease and Bronchiectasis. Presentation at ERS 2014.
Moving the Resistance Indicator simultaneously adjusts both resistance and frequency of oscillation. The lowest setting has the lowest resistance and the frequency of the oscillation will be lower. At the highest setting the resistance will be strong and the frequency of oscillations higher.
Selection of the proper resistance setting will produce the desired inspiratory:expiratory flow ratio of 1:3 or 1:4 for 10–20 minutes without excess fatigue. It is better to have a long, active exhalation efforts than a high resistance which could lead to fatigue and shorter exhalation efforts.
In a study of patients with bronchiectasis, use of an Oscillating PEP device showed sputum viscosity decreased whether the device was set at low or high pressure, suggesting that there is no need to generate high expiratory pressure to achieve the desired result.2 In addition, they showed that the longer patients maintained expiratory effort, exposing the mucus to constant oscillation, the better the effect.
Note: Helium-3 (3He) is a non-radioactive isotope of helium which when used during an MRI scan helps generate high-resolution images of the respiratory system. 3He MRI was used to produce detailed images of airway function, gas trapping and/or blocked airways and, most importantly, to understand how and where gas exchange was improving for patients after use of the Aerobika* Oscillating PEP. 3He MRI is a unique imaging tool for patients with COPD.
- Aids in lung hygiene and helps prevent infections1
- Improves gas transfer and lowers air trapping2
- Oscillations start at the beginning of each exhalation and continue through the end for maximum effect (see graph below)
- May help prevent lung infections
- Easy to learn for independent use
- Inexpensive and portable device
- Little interruption to daily living
- At least as effective as manual chest physiotherapy2
Studies supporting use of PEP and oscillatory PEP within clinical and in vitro environments.
A study conducted at Robarts Imaging at the University of Western Ontario using the Aerobika* Oscillating PEP device with Stage II and III COPD patients.
Source: 1 McCool FD, Rosen MJ. Nonpharmacologic Airway Clearance Therapies: ACCP Evidence-Based Clinical Practice Guidelines. Chest 2006;129(1):250S-259S. 2 Marks HJ. Airway Clearance Devices in Cystic Fibrosis. Paediatric Respiratory Reviews 2007;8:17-23. 3 TMI Aerosol Lab, Data on File: 4.0 mL Ipratropium bromide @ 15 L/min ± 5%; continuous delivery with an AEROECLIPSE* II Breath Actuated Nebulizer (BAN).