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The PEP-set consists of a breathing mask, one-way valve and eight different resistors.
Before use, fit a resistor in the expiration side of the valve - inside the white nozzle. The capacity of the resistor should be determined by the use of the PEP/RMT pressure gauge. The smaller the diameter, the higher the expiration resistance.
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1. The smallest diameter resistor that the patient can use effortlessly for 2 minutes, whilst simultaneously raising an expiration pressure of 10-15 cm water column, will prove to be the correct size. If the patient experiences discomfort, either the diameter is too small - or their technique is incorrect.
As a guideline, use a 1.5 mm resistor for infants and increase gradually to 2.5-3.0 mm for older children and adults not suffering form pulmonary diseases. 3.5 mm may be used for adults suffering from bronchial emphysema.
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2. The mask must make an airtight fit around the nose and mouth of the patient.
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Inspiration
Ask the patient to breathe slowly and deeply through the mask.
Expiration
The expiration must be slightly activated, but not forced. It is important that the patient yields to the resistance and breathes at a higher lung volume.
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3. Remove the mask from the patient's face after 10-15 respirations and ask the patient to breathe out forcefully - i.e. make long and forced expirations with the glottis open in order to move loosened secretions towards the trachea. Then ask the patient to cough.
Alternate between a series of respirations through the mask and forced breathing out and coughing until the patient feels free of secretions.
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4. In the beginning some assistance may be necessary to ensure that the mask is an airtight fit against the patient's face. An airtight fit is essential in order to obtain the desired effect. Apart from ensuring an airtight fit, patients can, in most cases, administer the PEP-set themselves (after careful instruction from a physiotherapist).
Giving information on their disease and what the patient can do to improve their own situation is an integral part of the treatment.
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5. A good treatment posture is to sit with the elbows resting on a table.
For acute diseases the PEP-set may be used several times daily.
For chronic cases the PEP-set should be used for 15 minutes 3 times daily. In a postoperative situation an hourly use of a PEP-set can have an atelectasis prophylactic effect.
For prophylaxis and atelectasis treatment a pressure of 15-20 cm water column is recommended, and for release of secretion obstruction in the pulmonary patient a 10-15 cm water column is recommended.
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