The addition of positive resistive pressure as the participant breaths out results in a prolongation of expiration which in turn may increase expiratory capacity and a reduction in gas trapping.Theoretically, PEP assists airway clearance in several ways: described an airway clearance method which required the subject to breathe through a flow-dependent PEP device attached to a face mask that created a PEP of between 10 and 20 cmH20 for 12 to 15 breaths. Originating in Denmark and defined as ‘the PEP technique’, Falk et al. Positive expiratory pressure devices can be used to assist airway clearance in individuals with excess secretions. Examples of airway clearance techniques include postural drainage, percussion, breathing exercises and positive expiratory pressure (PEP). To achieve this, airway clearance techniques apply external forces to the lungs and airways that manipulate lung volumes, pulmonary pressures and gas flow.
The primary aim of these techniques is to shear mucus and excess sputum from the inner surface of the airway lumen in the direction of the larger airways. There are a number of airway clearance techniques. From these larger airways mucus and any trapped inhaled particles or bacteria can be cleared, typically using a forced expiratory technique such as a cough or a huff. The rhythmic beating of the cilia acts as an escalator that moves the mucus from the smaller peripheral airways to the larger central airways. Mucus generating goblet cells produce a mucus film that sits on top of the cilia (hairs in the respiratory tract). Microorganisms hoping to infect the respiratory tract are caught in the sticky mucus and moved up the mucociliary escalator in the respiratory tract up to the pharynx or the part of the throat behind the mouth and nasal cavity and above the esophagus) an essential component of the lung defence protecting the lung and gas exchange regions from inhaled particles and bacteria which may lead to infection. In the conducting airways lined by ciliated epithelial cells (hair coated tissue cells in the respiratory tract, which move back and forth to help move particles out of the body), secretions are cleared by the mucociliary escalator (a major barrier against infection. For lung diseases that result in excess secretions, airway clearance techniques which improve mucus clearance are considered to be essential for optimising respiratory status and reducing disease progression.
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