What is IPEP (Intermittent Positive Expiratory Pressure)?
IPEP is not a recognized or established respiratory therapy technique in current clinical practice or medical literature. The term appears to be a confusion or conflation of two distinct respiratory therapy modalities: IPPB (Intermittent Positive Pressure Breathing) and PEP (Positive Expiratory Pressure), which have fundamentally different mechanisms and clinical applications.
Clarifying the Terminology
IPPB (Intermittent Positive Pressure Breathing)
- IPPB provides positive pressure throughout inspiration to augment tidal volume, not during expiration 1
- The technique delivers controlled pressure during the inspiratory phase to assist ventilation or lung expansion 2
- IPPB has very limited evidence for effectiveness in bronchiectasis, with one small study (n=18) showing no significant changes in pulmonary function or walking distance 1
- IPPB is generally not recommended as it offers no advantage over simpler therapies for COPD, asthma, or postoperative atelectasis 2
- It may only be useful in patients at risk of respiratory failure from neuromuscular disorders or kyphoscoliosis, or in acute severe bronchospasm failing standard therapy 2
PEP (Positive Expiratory Pressure)
- PEP involves breathing out against resistance to create positive pressure during expiration, not inspiration 3
- The technique builds up gas behind mucus via collateral ventilation and temporarily increases functional residual capacity 4
- PEP is strongly recommended by the British Thoracic Society for patients with bronchiectasis, specifically offering "oscillating positive expiratory pressure" as a first-line airway clearance technique 1
- PEP using a mask (not mouthpiece) for at least one year significantly reduces respiratory exacerbations compared to other techniques in cystic fibrosis (five studies, 232 participants, moderate- to high-quality evidence) 4
- In COPD patients with daily sputum production, oscillatory PEP (Acapella device) improves cough-related quality of life (LCQ improvement 1.03, p=0.03) and reduces cough frequency by 60 coughs/24 hours (p<0.001) 5
Key Mechanistic Differences
IPPB works during inspiration:
- Delivers positive pressure to inflate lungs 2
- Effects are short-lived (approximately 1 hour) 2
- Requires mechanical respirator 2
PEP works during expiration:
- Creates back pressure to airways during exhalation 4
- Prevents airway collapse and improves secretion clearance 3
- Uses simple handheld devices (masks or mouthpieces with resistors) 1, 4
Clinical Recommendation
If you are seeking an airway clearance technique for secretion management, use PEP (specifically oscillating PEP devices like Acapella), not IPPB. The British Thoracic Society explicitly recommends offering oscillating positive expiratory pressure to individuals with bronchiectasis 1. PEP should be performed with a mask rather than mouthpiece to avoid air leaks and maximize effectiveness 4. Patient preference strongly favors PEP over other techniques in studies with intervention periods of at least one month 4.
Common Pitfall to Avoid
Do not confuse EPAP (Expiratory Positive Airway Pressure) used in BiPAP/NIV settings with PEP therapy 1, 6. EPAP is a ventilator setting that maintains continuous positive pressure during expiration in mechanically ventilated or NIV patients 1, while PEP is an active airway clearance technique performed by spontaneously breathing patients using handheld devices 3, 4.