Fig. 19:  There are many devices with varying degrees of positive expiratory pressure (PEP) that can be used in patients if instability of airways is a prominent cause of cough insufficiency. An Italian company developed the UNIKO-TPEP, which creates a temporary positive expiratory pressure during expiration.  A study in 98 patients with COPD, chronic bronchitis, or bronchiectasis producing >30 mL sputum per day, showed at the end of a treatment period of 10 days higher lung volumes and subjectively less bronchial encumbrance with use of the TPEP for two 15-minute sessions per day.^[15]  Geiseler J. Chest 2016;00. 

Reference:

15. Venturelli E, Crisafulli E, Debiase A, et al. Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO (R) project: a multicentre randomized controlled trial. Clin Rehabil 2013; 27 (4): 336-346. The UNIKO (R) project: a multicentre randomized controlled trial. Clin Rehabil 2013; 27 (4): 336-346.