2020/09/15 by Angela M Demchuk, Robert L Chatburn
Medicine · #Cystic Fibrosis Research Advances #Inhalation and Respiratory Drug Delivery #Tracheal and airway disorders
paper · pdf · doi:10.4187/respcare.08150
crossref issued 2020/09/15 · crossref published 2020/09/15 · crossref published-online 2020/09/15 · openalex publication_date 2020/09/15 · crossref created 2020/09/15 · crossref published-print 2021/03/01 · openalex created_date 2025/10/10 · crossref deposited 2026/04/06 · crossref indexed 2026/07/30 · openalex updated_date 2026/07/30
BACKGROUND: Positive expiratory pressure (PEP) therapy imposes expiratory flow resistance to increase airway diameter and enhance mucus clearance. PEP is achieved several ways. Oscillatory PEP devices (OPEP) generate repeated occlusions that are known to reduce mucus viscosity. There are many marketed devices, but comparative performance is mostly unreported. The purpose of this study was to evaluate performance characteristics of many PEP/OPEP devices. For OPEP devices, we defined an optimal performance metric by creating an oscillation index that combines the OPEP performance characteristics. METHODS: PEP devices (TheraPEP, EzPAP, VersaPAP, Resistex, AccuPEP, AccuPAP, and Threshold PEP) and OPEP devices (Acapella DH, Acapella DM, Acapella Choice, ShurClear, Aerobika, VibraPEP, vPEP, and PocketPEP with and without the Oxyjet attachment) were tested by adjusting simulated expiratory flow from 5 L/min to 30 L/min in increments of 5 L/min using a standard flow meter. RESULTS: O across all settings. For OPEP devices, there was a major difference between pressure and flow waveforms. The Acapella DH, ShurClear, and Aerobika showed the highest flow amplitude, flow frequency, and oscillation index. CONCLUSIONS: PEP devices behaved similarly and as expected, with increased pressure with increased flow (flow resistors) or flow independence (threshold resistors). There was much greater variation in the performance of the OPEP devices. A higher oscillation index indicates better mechanical performance characteristics. Many devices have similar characteristics. However, the devices with the highest oscillation index have the highest flow amplitude and frequency, which may indicate better clinical performance.