Effects of Acapella versus Blow Bottle Positive Expiratory Pressure on Airway Clearance and Peak Expiratory Flow Rate in Post-Covid-19 Patients

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Muhammad Nouman Khar
Rabbyya Kausar
Reeham Akbar
Muhammad Rehan Ijaz Khan
Noor Ul Huda
Gullnaz Yousaf
Sidra Faisal


Background: The COVID-19 pandemic has led to significant respiratory complications in affected individuals. Positive Expiratory Pressure (PEP) devices, specifically Acapella and blow bottle devices, have been widely used in respiratory rehabilitation, particularly in patients with pulmonary diseases and post-surgical respiratory complications. However, their efficacy in post COVID-19 patients has been less explored.

Objective: This study aimed to compare the effectiveness of Acapella and blow bottle devices in improving oxygen saturation, peak expiratory flow rate, shortness of breath, and six-minute walk distance in post COVID-19 patients.

Methods: This randomized clinical trial was conducted at Tehsil hospital Kot Addu over six months. Forty-eight post COVID-19 patients were divided equally into two groups: one group received treatment with the Acapella device, and the other with a blow bottle device. Baseline and post-treatment measurements of oxygen saturation, peak expiratory flow rate, and six-minute walk distance were recorded using a pulse oximeter, peak expiratory flow meter, and six-minute walk test, respectively.

Results: On day 1, the Acapella group showed a mean oxygen saturation rank of 20.98 with a sum of ranks of 503.50 (p=0.79), while the Blow Bottle group had a mean rank of 28.02 and a sum of ranks of 672.50. By day 7, the Acapella group's mean rank was 17.31 (sum of ranks = 415.50, p=0.000) compared to the Blow Bottle group's 31.69 (sum of ranks = 760.50). For peak expiratory flow rate, no significant differences were found between the groups at day 1 (Acapella: mean rank = 28.06, sum of ranks = 673.50, p=0.078; Blow Bottle: mean rank = 20.94, sum of ranks = 502.50) and day 7 (Acapella: mean rank = 23.77, sum of ranks = 570.50, p=0.717; Blow Bottle: mean rank = 25.23, sum of ranks = 605.50). Similar trends were observed in the six-minute walk test results.

Conclusion: The study found that both Acapella and blow bottle devices effectively improve oxygen saturation in post COVID-19 patients, but do not significantly affect peak expiratory flow rate, shortness of breath, and six-minute walk distance. These findings suggest that while these devices are beneficial for enhancing oxygenation, a more comprehensive respiratory rehabilitation approach is necessary for addressing the full spectrum of respiratory complications in post COVID-19 patients.

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How to Cite
Khar, M. N., Kausar, R., Akbar, R., Khan, M. R. I., Huda, N. U., Yousaf, G., & Faisal, S. (2024). Effects of Acapella versus Blow Bottle Positive Expiratory Pressure on Airway Clearance and Peak Expiratory Flow Rate in Post-Covid-19 Patients. Journal of Health and Rehabilitation Research, 4(1), 161–166. https://doi.org/10.61919/jhrr.v4i1.355
Author Biographies

Muhammad Nouman Khar, National Hospital Lahore

Clinical Physiotherapist.

Rabbyya Kausar, University of Lahore Sargodha Campus


Reeham Akbar, Iqra Medical Complex- Lahore


Sidra Faisal, Riphah International University- Lahore



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