Airway Clearance Devices for Cystic Fibrosis

Beyond Manual Chest Physiotherapy

Girl using an oscillating PEP device

Manual chest physiotherapy (CPT), postural drainage, breathing exercises, coughing—all of these are basic airway clearance techniques that everyone who has cystic fibrosis (CF) must know how to do. Eventually, though, most people with CF will also use assistive devices to help them get the job done. These are some of the most commonly used airway clearance devices.

Positive Expiratory Pressure

Positive expiratory pressure (PEP) devices are portable, inexpensive and do not require electricity.

The PEP device is either a mask or a small hand-held mouthpiece with a one-way valve that allows air to flow in easily but creates a resistance during exhalation. PEP helps inhaled air get behind the mucus in the lungs and then holds the airway open, so the mucus can be pushed out. PEP is done by breathing in and out through the device several times, then huffing to remove the loosened mucus.

Some brands, such as PARI PEP, can be connected to a nebulizer to combine PEP therapy with aerosolized bronchodilators. By delivering two treatments at once, PEP nebulizers shorten the amount of time spent on therapies.

Oscillating Positive Expiratory Pressure

Just like PEP devices, oscillating positive expiratory pressure (oscillating PEP) devices are small, portable and inexpensive mouthpieces that do not require electricity. Oscillating PEP works in the same way as PEP with an added bonus: oscillating PEP also uses vibration to help shake the mucus loose.

The vibration is created by air flowing over a steel ball or magnet inside the device during exhalation.

Some common brands of oscillating PEP devices:

    High-Frequency Chest Wall Oscillation

    High-frequency chest wall oscillation (HFCWO) uses a vest that rapidly inflates and deflates to loosen mucus through vibration. The vest is used instead of doing manual CPT. Its main benefit is a convenience because HFCWO is quicker than manual CPT and does not require the help of another person. Convenience doesn’t come cheap, though. The vest is very expensive and is not always covered by insurance.


    Marks, J.H. “Airway Clearance Devices in Cystic Fibrosis”. Paediatric Respiratory Reviews. 2007; 8:17–23. 20e.