Follow this advice to best clear secretions from your chest using your device. It should be used with advice from your respiratory physiotherapist, who may make modifications based on your individual needs. It should also be read in combination with the manufacturer’s supporting information.

Some people with chronic lung conditions find they have mucus (sputum) which can be difficult to clear.

An oscillating positive expiratory pressure (OPEP) device is a drug-free, easy to use, hand-held device. It uses resistance to make it more difficult to breathe out, creating vibrations which help move mucus from your airways.

If you use your device regularly it may:

• reduce your need to cough throughout the day
• improve feelings of breathlessness
• keep your airways open as you breathe out
• provide vibrations in your lungs which help to loosen the mucus
• help reduce the number of infections, especially those requiring hospitalisation
• reduce any further damage to your lungs
• support drug free, natural airway clearance.

Although coughing is the most common way of clearing mucus and secretions, it is also quite hard work and can lead to fragile airways becoming irritated. Where possible, try to limit the amount of coughing you do. It is much better and easier to move secretions up through your lungs by using your device.

How do I use my OPEP device?

1. Wash your hands before you start.
2. Get into a comfortable position, with your shoulders and arms relaxed. The device can be used sitting, lying down or in a particular position advised by a respiratory physiotherapist.
3. Breathe in slowly through your nose, at a comfortable speed.
4. Breathe out through your mouth, at a comfortable speed, not into the device yet. Avoid letting your shoulders rise. You should feel your tummy softly moving in and out with your breathing.
5. Maintain this relaxed breathing for one to two minutes, or as advised by your respiratory physiotherapist.
6. Set the device to setting ___________________.
7. Place the mouthpiece in your mouth and make sure you have a tight seal around it with your lips.
8. Breathe in slowly through your nose and slightly deeper than normal.
9. Pause for two to five seconds to allow your lungs to fill properly.
10. Breathe out through the device at a steady rate so you feel the vibrations in your chest. Continue to a comfortable level.
11. Try to make sure your cheeks stay still as you breathe out. They should not vibrate.
12. Repeat breaths in and out through the device __________ times or as advised by your respiratory physiotherapist.
13. Try to suppress your cough during these breaths.
14. Repeat relaxed breathing for another one to two minutes.
15. If you can feel mucus ready to be cleared, try __________ huffs or coughs using the instructions in this advice.
16. Repeat this for __________ sets.

If you are taking inhaled medication, you should take _____________________________ before and/or _____________________________ after.

If you are taking hypertonic saline through your device, attach the nebuliser chamber to the back of the device, and switch the nebuliser on. Continue with your physiotherapy as directed above. Please make sure the nebuliser is cleaned after each use.

Huffing

Huffing is designed to move secretions from the smaller airways upwards to where it is

easier to cough and clear. This technique requires practice and should be checked by a respiratory physiotherapist to make sure you are being as effective as possible. It may not be necessary to huff after every set of breaths through your device, however, you should try to do one or two towards the end of each session to make sure any secretions are cleared.

1. Take a slow breath in through your nose, a little deeper than normal, but not all the way in.
2. Open your mouth to an ‘O’ shape and huff the air out, as if you are trying to steam up a mirror.
3. You should feel your tummy muscles working to push out the air.
4. The secretions should move upwards so you can cough them up or perform a short, sharp huff to move them into your mouth.
5. Avoid huffing too hard as excessive force may make you wheezy.
6. If done correctly, you should hear crackles as you breathe out. This may be quite subtle and quiet if there are not many secretions or louder and coarser if there are a lot of secretions.
7. Limit the number of huffs to one or two to reduce the chance of becoming wheezy or having a coughing fit.

Breathing cycle

Start and finish by settling and controlling your breathing. Keep working through this cycle for ___________________.

Use your device __________ times a day to maintain your chest clearance when you are well. If you have a chest infection you may need to increase this.

Cleaning your device

Cleaning your device properly is very important to decrease the risk of infection. The device should be cleaned every night before bed. That way when you wake up in the morning it will be clean and dry, ready to use.

1. Take the device apart. There are four parts to clean: Top case, bottom case, mouthpiece and the valve cartridge.
2. Soak the parts in lukewarm soapy water (warm water and dishwashing liquid) for 15 to 20 minutes.
3. Rinse in lukewarm tap water and place the parts on a clean towel or kitchen roll to air dry completely before reassembling the device. Do not rub it dry. Alternatively, the device is dishwasher safe for the top rack of the dishwasher. We recommended putting the separate parts in a small basket to avoid them getting lost. Make sure it is fully dry before reassembling it.

Disinfecting your device

Always clean your device before disinfecting it. It should be disinfected at least once a week using one of the methods below.

Boil a pan of tap water and simmer the parts for five minutes. Place the parts on a clean towel or kitchen roll to air dry before reassembling.

Or sterilising in a solution containing Milton fluid or a Milton tablet following the manufacturer’s instructions.

If you have a chest infection, you should disinfect your device daily for the duration of the infection.

Your device should be replaced either every 12 months or immediately if it is damaged.

Contact your GP for a prescription for a replacement device.