Chart — Clinical Skills
Lung Expansion Therapies Compared
Incentive spirometry, IPPB, CPAP, or PEP for atelectasis? This grid sorts the lung-expansion therapies by mechanism and the patient capability each one demands, so the choice fits the patient in front of you.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Lung Expansion Therapies
| Therapy | Mechanism | Patient Requirement | Best Use |
|---|---|---|---|
| Incentive Spirometry (IS) | Patient-generated sustained maximal inspiration raises transpulmonary pressure | Spontaneously breathing, cooperative, adequate inspiratory effort | Preventing post-op atelectasis in cooperative patients |
| Deep Breathing & Early Mobilization | Voluntary deep breaths plus activity | Cooperative | First-line adjunct after surgery |
| IPPB (Intermittent Positive Pressure Breathing) | Machine-delivered positive-pressure breaths expand the lungs | Cannot take an adequate breath voluntarily; short treatments | Atelectasis in patients unable to perform IS; can co-deliver medication |
| CPAP (Mask) | Continuous positive pressure splints alveoli open and raises FRC | Spontaneously breathing | Atelectasis refractory to IS |
| EPAP / PEP | Expiratory positive pressure | Cooperative | Atelectasis combined with secretion retention |
How to Use This Chart
Choosing the right lung expansion therapy hinges on what the patient can do independently versus what the device must supply. The five modalities span a continuum from fully patient-driven effort to machine-delivered pressure support.
- Effort vs. pressure.IS depends on the patient’s own inspiratory effort, while IPPB and CPAP apply machine-delivered positive pressure for patients who cannot generate adequate effort on their own.
- IS is an inspiration maneuver. Incentive spirometry is a sustained inspiration, not an exhalation maneuver — clarify this with every patient instruction.
- Combine with mobilization. Pair any lung-expansion therapy with early mobilization and a directed cough for best outcomes.
Related Resources
Sources
- Restrepo RD, Wettstein R, Wittnebel L, Tracy M. AARC Clinical Practice Guideline: Incentive spirometry: 2011. Respir Care. 2011;56(10):1600-1604.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Lung expansion therapy.