How to use an OPEP Aid

 OPEP means Oscillating Positive Expiratory Pressure Therapy System

The Acapella Choice, Aerobika, Flute, PARI-O-PEP, Quake and Flutter are all OPEP devices. The following directions apply to all these devices. The manufacturer’s include instruction how to use their device.

If possible, see an Experienced Physiotherapist or Respiratory Physician for more detailed and specific instructions on using their devices for your own personal situation

You can find where to buy each aid in the “Airway Clearance/Airway Clearance Aids” subject

Comment: If you do not clear your airways each day, the mucus in your lungs will build up and become a breeding ground for the bacteria. Your ability to get well again will impeded.

You may find some movements described below, difficult to do. Don’t be frightened to try your own variations. You may find an alternative way that works better for you. No matter what method you adopt, it is a matter of practice, practice and practice some more to get the best result.

How do OPEP devices work:

Your airways have tiny hairs called Cilia (pronounced: sih-lee-uh). Cilia have a rhythmic, waving motion, moving back and forth. They work by pushing debris and mucus upwards towards the throat, where it can be swallowed or coughed up. The oscillating action of these devices are designed to cause the air in your lungs on exhalation, to move in rhythm with the action of the cilia, reinforcing the cilia’s natural action to move the sticky and viscous mucus produced by your lung infection out of your lungs.

OPEP devices also allow you to adjust the positive pressure in your lung when exhaling. This helps to open up the airways and get air behind the secretions to help break the mucus away and move the mucus higher up the airway.

Comment: Removing mucus from your lungs will be easier and you will get better results when your mind and body are fully relaxed. It really does not matter what you do to relax, Meditation, Yoga, Cardiovascular Exercise or any other method that works for you. Your objective is to clear your mind from everything that is going on, and let your mind and body go loose and free.  Yes, it is lot easier to make these suggestions, but quite another thing in practice. Just do the best you can, and try to do better each time.

Tip: When you begin using an OPEP device, set the back pressure at the lowest possible setting. Gradually increase the back pressure over time, but not to a point when you have to push hard to exhale..

If at any time you recognize you are not relaxed, pause and let everything go

 Comment: Here are a couple of internet sites that you may find useful at this time

http://www.abc.net.au/health/library/stories/2008/12/16/2440879.htm

http://www.thoracic.org/copd-guidelines/for-patients/anatomy-and-function-of-the-normal-lung.php

How to use an OPEP device:

In the beginning, spend 10 minutes getting all your day to day issues, out of your mind. Just think about, and feel the air quietly, moving in and out of your nose

Step 1:Inhale

Relax your facial muscles, throat and chest. Hold the OPEP device mouthpiece SOFTLY in your mouth. Hold your head slightly backwards to open up your wind pipe. Inhale gently. DO NOT STRAIN. Use your abdomen muscles to draw your Thoracic Diaphragm down to fill your lung midway only. Hold your breath for the count of three.

Step 2: Exhale

Hold the OPEP device mouthpiece firmly with your mouth and tighten your facial muscles, so they are firm, but not strained. We do not want your cheeks to vibrate excessively when you exhale.

Use your abdomen muscles to push the air out of your lungs. At the same time, we want you to keep your upper body, arms, shoulders and throat relaxed, and your facial muscles firm. You can do this by focusing your mind on your abdomen muscles, letting the rest of your body stay relaxed and loose. It is very easy to tighten up your chest when exhaling. This can cause your throat to tighten and the rate of air traveling up your wind pipe, carrying the mucus will be reduced.

Step 3: Repeat Inhaling and Exhaling ten times 

Tip: Use a pencil and paper to mark a count of five, twice. Because your mind is busy whilst you are inhaling and exhaling, it is very easy to lose track of how many times you have breathed in and out.

Step 4: Controlled Breathing

Take a slow deep, but unforced, breath in through your nose

Open your mouth wide keeping your facial muscles, neck and body relaxed

Breath out, just letting your abdominal muscles relax. Make a sighing sound as air in your lungs escapes. Let your body go and feel the tension in your body disappear

Repeat up to three times

Finish with a few normal relaxed breaths

Step 4: Huffing

Open your mouth, so it is fully open, but not strained. Incline your head slightly backward, to open up your windpipe. Keep your throat relaxed. take a middle size breath in, and then tighten your abdomen muscles to push out the air from deep in your lungs in a burst. Feel the air moving up through your lung and throat. As you exhale make a sound like a “Huff” as if you are fogging up a mirror. (You need to exhale firmly to force air out fairly fast, but never in a forced manner.) 

Tip: Ask your medical centre for a couple of mouth pieces used for lung function tests. They are most often made out of cardboard, but surprisingly they last a long time. Buy some Rubbing Alcohol and get a small bottle with a spray top to spray the alcohol over the mouth piece. Put the lung function mouth piece in your mouth as far as it is comfortable. Hold the lung function mouth piece loosely with your mouth whilst huffing

When you “Huff” you might find it helps to put an open hand in front of your mouth and imagine it is the mirror you are fogging up.

Step 5: Pause

You may find it beneficial to relax and just breathe normally for a short while, before moving on.

 Step 6: Repetitions

Repeat the above Steps 1 to 5, until you begin to hear the mucus crackling in your throat and you can feel the mucus collecting in the top of your throat.

Try to avoid coughing, until you get that irresistible urge to cough

Step 7: Productive Cough:

Comment: For some people, they will find the above method will cause them to have an irresistible urge to cough. The mucus just erupts out of their throat. For others it is VERY difficult to cough productively and remove the mucus from their airways. For these people, it can take months to have a really productive cough

A productive cough starts from deep in your lungs and contains a large rush of air followed by a relaxed cough

If the cough is shallow, forced, vigorous, explosive or uncontrolled, it can cause your airways to collapse and spasm, trapping mucus.

To cough effectively:

  1. Sit on a chair, or on the edge of your bed, with both feet on the floor. Alternatively, you may find coughing more successful, when standing.
  2. Fold your arms across your abdomen. Breathe in again by “sniffing” slowly and gently through your nose. This gentle in-breath helps prevent mucus from moving back down your airways.
  3. Lean forward slightly, pressing your arms against your abdomen. Cough 2-3* times through a slightly open mouth. Coughs should be short and sharp, but not forced. Remember an effective cough comes from deep in your lungs. It is a controlled firm RELAXED movement.

Comment: REMEMBER coughing can be VERY exhausting. When you are fully relaxed and able to control the coughing action, you will NOT be exhausted.

Don’t be concerned if it takes 20 minutes or sometimes hours, after completing the Breathing and Huffing stages, before you get that irresistible urge to cough

Step 8: Clean Up

Wash the OPEP device in warm water with a little detergent and rinse it in clean water after each use

Once a week, sterilize the OPEP device by one of these methods

Boiling in water for 10 minutes

Washing in alcohol for 5 minutes

Using a microwave sterilizer

Tip: A Phillips Advent microwave sterilizer is a convenient solution. They are readily available from BigW and other popular stores