Mucus buildup and breathing difficulties are daily challenges for people living with chronic lung conditions. Positive Expiratory Pressure (PEP) therapy provides a simple yet effective way to help clear mucus and support better lung function.1,2,3 Choosing the right PEP device is key, as each works differently and requires varying levels of patient effort.
In this article, we’ll compare traditional devices like EzPAP, Aerobika, and Acapella to multi-therapy systems like BiWaze® Clear, an electronically controlled PEP system that delivers consistent therapy with digital pressure settings, electronically regulated flow, and integrated high-frequency oscillation and vibrating mesh aerosol delivery.4,5,6,7
Positive expiratory pressure therapy is a non-invasive airway clearance technique. The therapy generates a back pressure during exhalation, sometimes combined with oscillations that loosen secretions.2,9
Patients exhale against resistance, which helps:
PEP therapy is commonly prescribed for conditions such as:
Therapy sessions usually last 10–20 minutes and can be performed at home, making it convenient for long-term care.1,9 Regular use is important for maintaining consistent results.
Patients are encouraged to incorporate PEP therapy into their daily routines, therefore selecting an effective PEP device is critical. Consistency is key to experiencing long-term benefits.1,2
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PEP Valve (Traditional PEP) |
Basic resistance devices (e.g., EzPAP) primarily used in the hospital setting. |
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Oscillating PEP (OPEP) |
Combine resistance with vibrations to loosen mucus (e.g., Acapella, Aerobika).2,10 |
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Electronically Controlled PEP |
Deliver digitally set expiratory pressure with electronically regulated flow (e.g., BiWaze Clear).4,7 |
OPEP devices like the Aerobika, and Acapella are widely prescribed but do not offer patients the ability to deliver precise, electronically controlled PEP. Traditional PEP and OPEP devices also do not integrate aerosol delivery, requiring separate equipment. BiWaze Clear delivers oscillating lung expansion (OLE) therapy, combining high-frequency oscillation, electronically controlled PEP, and vibrating mesh aerosol delivery into a single therapy session.4,5,6,11
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| Example Devices / Type of PEP | EzPAP (Traditional PEP) | Acapella / Aerobika (OPEP) | BiWaze® Clear |
| Mechanism | Basic resistance valve | Counterweight in plastic housing creates oscillations | Electronically controlled PEP with digital pressure settings & regulated flow |
| Consistency of Pressure | Patient-effort dependent | Variable, based on technique | Consistent, repeatable digitally set expiratory pressure |
| Oscillation / Vibration | ❌ Not available | ✔️ Vibration (inconsistent) | ✔️ Electronically delivered oscillations (consistent) |
| Nebulization Included | ❌ Requires separate device | ❌ Requires separate device | ✔️ Integrated vibrating mesh aerosol delivery |
| Patient Effort Required | High | Moderate | Low – electronically controlled delivery reduces patient effort |
| Best Used For | Patients with strong effort and simple needs | Patients who tolerate oscillation effort | COPD, bronchiectasis, pneumonia, or patients needing consistent airway clearance |
| Designed for Mucus Clearance | ✔️ If used correctly | ✔️ With added oscillations | ✔️ Supports consistent mucus clearance |
| Limitations | Technique dependent | Effort dependent, no aerosol integration | Requires power source to charge built-in battery |
Traditional PEP and OPEP devices like EzPAP, Aerobika, and Acapella remain commonly used for airway clearance, but they rely heavily on patient effort, are variable based on patient effort, and require separate devices for aerosol delivery. BiWaze Clear represents a different approach, providing electronically controlled PEP with integrated high-frequency oscillation and vibrating mesh aerosol therapy.
Ready to see how BiWaze Clear can support your patients’ respiratory therapy? Contact us today to learn more.
How does an oscillating PEP device differ from BiWaze Clear?
Oscillating devices like Acapella and Aerobika create vibrations but still depend on patient effort. BiWaze Clear electronically delivers controlled pressure and oscillations, reducing variability.
Can a PEP device help clear mucus?
Yes. PEP therapy devices are designed to loosen mucus so it can be coughed out. BiWaze Clear supports more consistent therapy delivery with electronically controlled settings.
Can people with COPD or bronchiectasis use a PEP device?
Yes. PEP therapy is widely used for COPD, bronchiectasis, cystic fibrosis, and pneumonia. BiWaze Clear’s electronically controlled pressure and oscillation may be especially helpful for patients with variable lung function.
Can PEP therapy be combined with other treatments?
Traditional devices usually focus only on resistance breathing. BiWaze Clear integrates PEP, oscillation, and aerosol therapy into a single 10-minute session, saving patients time and effort.
Can I use a nebulizer with traditional oscillating PEP (OPEP) devices like Acapella or Aerobika?
Traditional OPEP devices such as Acapella and Aerobika are designed for mucus clearance but do not include integrated aerosol therapy. To deliver nebulized medication, patients typically need a separate nebulizer system (jet or vibrating mesh). This often means completing two separate treatments, one for airway clearance and one for aerosol delivery, taking 20-30 minutes or more.
How does BiWaze Clear integrate nebulizer therapy differently?
BiWaze Clear has a built-in vibrating mesh nebulizer. This allows aerosolized medication delivery at the same time as PEP and high-frequency oscillations (HFO). Patients can complete three therapies in one 10-minute session, PEP, oscillation, and aerosol delivery—, educing treatment burden and supporting adherence.
Is there evidence that integrated nebulization with BiWaze Clear is more effective?
Yes. An independent in vitro study conducted by Rob DiBlasi and colleagues from Seattle Research Institute compared aerosol delivery efficiency across Oscillating Lung Expansion (OLE) systems with integrated nebulizers. Results showed that BiWaze Clear delivered significantly greater aerosol deposition compared with other devices. This suggests that BiWaze Clear’s integration of vibrating mesh aerosol with consistent, electronically controlled PEP and oscillation may provide patients with more efficient and reliable medication delivery during airway clearance sessions.6
Why does combining PEP, oscillation, and nebulization matter for patients?
Combining these therapies reduces the overall time required for daily treatments while ensuring consistent airway clearance and medication delivery. For patients with COPD, bronchiectasis, or cystic fibrosis, who may need multiple therapies daily, this integration can improve adherence and quality of life by streamlining therapy into a single session.
Which patients may benefit most from BiWaze Clear’s integrated nebulizer?
Patients who:
