PEP exercise and bottle blowing

PEP device exercises, such as bottle blowing, are effective ways of removing excess mucus. Another effective mucus removal method is physical exercise.

When you blow through a tube into water in a bottle, the pressure in the airways increases. This opens up the passageways between bronchioles, allowing air to flow behind the mucus and push it into the larger airways. This way, it will be easy to remove the mucus by coughing or huffing.

In addition to removing excess mucus, bottle blowing strengthens the respiratory muscles. You can choose the resistance during the exercise. You can increase pressure in the airways by putting more water into the bottle or by using a thinner tube.

If you have a contagious respiratory infection, do the bottle blowing exercise somewhere where there are no other people around. This reduces the risk of infecting others.

If you have heart disease or difficult COPD, talk to your physician before starting PEP therapy.

A bubble PEP device is a good device for these exercises. There are also other types of PEP devices. Some PEP therapy devices are oscillating devices, which may boost the removal of excess mucus.

Bottle PEP therapy instructions

Items you need

  • 1-litre bottle.
  • Plastic tube with a 7–10 mm diameter. The tube should be 50–70 centimetres long.


  • Pour about 10 centimetres of water into the bottle. In advanced COPD, 5–6 centimetres of water is enough.
  • Push the tube through the mouth of the bottle all the way to the bottom.

Blowing position

  • Sit at a table with good posture.
  • Hold the bottle with one hand and the tube with the other.
  • If necessary, support your elbows on the table.

Blowing technique

  • Put the tube in your mouth. Put your lips firmly around the tube.
  • Calmly breathe in through your nose and out through your mouth. Breathe with your diaphragm.
  • Breathe out through the tube slightly more intensely and for longer than normal.
  • You will know that you are blowing intensely enough when the water is bubbling.
  • Blow 10 to 15 times. Repeat this sequence two or three times.
  • Take a short break between rounds.
  • When mucus rises up, get it out of your airways by coughing or huffing.
  • You can use this technique to remove excess mucus 3 to 4 times per day.
  • When you are finished, wash the bottle and tube with dishwashing liquid. Do this after each exercise session. If necessary, dip the bottle and tube in boiling water.