Oscillatory Positive Expiratory Pressure: The Ball Game for Your Lungs

Oscillatory Positive Expiratory Pressure: The Ball Game for Your Lungs

Oscillatory Positive Expiratory PressureOscillatory positive expiratory pressure (OPEP) therapy helps mucus secretion and lung function by creating positive pressure and vibration in the lungs. This can be achieved by simultaneously exhaling against resistance and creating oscillation or vibration. During OPEP, the inhale is unloaded, so the user is asked to inhale first and then to exhale through the device. There are different ways to create vibration. A very effective way is to move a steel ball in a confined space with the exhaled air, thereby creating the vibratory effect.

What does OPEP do?

The combination of positive pressure and vibration generated with OPEP offers several benefits:

  • OPEP helps to loosen the mucus from the walls of the airways for easier secretion
  • The positive pressure supports the transport of the mucus out of the airways
  • The positive expiratory pressure (PEP) also promotes lung expansion and helps to unblock airways
  • OPEP maximizes lung capacity
  • PEP can help recruit underutilized parts of the lungs
  • OPEP helps to reduce mucus build-up, e.g., after infection
  • OPEP helps remove pollutants and inhaled allergens
  • OPEP promotes airway clearance and pulmonary hygiene, thereby reducing the risk of new infections and pneumonia

Who benefits from OPEP?

OPEP is a suitable therapy to support mucus secretion and airway clearance and may help people at risk of retained secretions or at increased risk of infection. It has proven effective in airway clearance in people affected by conditions including COPD, asthma, atelectasis, bronchiectasis, bronchitis and emphysema, cystic fibrosis, and others.

OPEP greatly supports pulmonary hygiene and may, therefore, reduce the risk of pneumonia, for example, in people with dysphagia or swallow dysfunction, where aspiration of food particles can provide a breeding ground for bacterial infections. Further, people undergoing major thoracic or abdominal surgery may benefit from improved airway clearance before and after surgery, with the aim to reduce postoperative pulmonary complications such as atelectasis and pneumonia.

Several conditions, such as spinal cord injury, are also associated with mucus build-up due to ineffective cough, reduced mobility, and prolonged seated or reclined positions. OPEP can help here to prepare the mucus for easier removal from the lungs, again reducing the risk of airway infections.


Matching OPEP with an additional system that increases respiratory muscle strength, such as The Breather or Breather Fit, can be a particularly successful combination in strengthening the cardiopulmonary system as well as enhancing exercise performance. Respiratory muscle training (RMT) using the Breather increases both inspiratory and expiratory muscles, improving air intake, peak expiratory flow, and cough effectiveness. The mucus loosening effect of OPEP coupled with more effective respiratory muscle function for improved cough and expectoration, therefore, offers a winning combination.

OPEP for athletes

The Benefits of OPEP may also be beneficial for athletes and para-athletes. By contributing to optimal lung expansion, it maximizes the O2 and CO2 gas transfer. Increased efficiency in providing oxygen for exercising muscles and in CO2 removal can increase your performance and endurance while reducing your recovery time. Exercising, as well as respiratory muscles, are provided with sufficient amounts of oxygen to keep working harder for longer, delaying the lactate threshold and limitation of exercise.

OPEP is best used before working out to expand lung capacity, preparing them for the workout by removing mucus and pollutants.

The AirPhysio

Oscillatory Positive Expiratory PressureThe AirPhysio is an international award-winning OPEP device newly designed to provide you with all the benefits of OPEP therapy in a stylish and more colorful way than comparable devices.

Made in Australia, it contains a steel ball bearing, which oscillates during forceful exhale, thereby exercising the airway walls and muscles, making them expand and contract at a frequency of 16-40 Hz.

In contrast to other devices, the AirPhysio can be disassembled for thorough cleaning, reducing the risk of infection. The AirPhysio comes in a patient and a sports version (AirPhysio Sports).

How to use the AirPhysio

OPEP is a very simple, effective, and cost-effective therapy. 

To use, sit upright, hold the AirPhysio with the ball bearing facing upwards. Inhale deeply through either nose or mouth, then forcefully exhale through the device without puffing your cheeks. For optimal benefit, use diaphragmatic breathing, drawing the air into your belly on the inhale, and pushing the air out using your diaphragm and your abdominal muscles during exhale.

OPEP therapy can be applied as needed, with a recommended 5 to 10 minutes twice a day for best outcomes.

Learn more about the AirPhysio