Original Editor - Erika Rodrigues

Top Contributors - Erika Rodrigues  

Background[edit | edit source]

Positive expiratory pressure therapy (PEP) is used to enhance mucus clearance by either preventing the airways from collapsing by stenting them or through collateral ventilation that helps in increasing the intrathoracic pressure distal to the retained secretions or by increasing the functional residual capacity. Oscillatory Positive Expiratory Pressure (OPEP) therapy was first developed in Switzerland. OPEP therapy combines the positive effects of PEP therapy with vibrations or oscillations and therefore has a two-fold effect on airway clearance.[1]

Introduction[edit | edit source]

The cornet is an OPEP device. It consists of a semi-circular plastic tube. The exhaled air passes through the curved plastic tube which contains a flexible, latex-free hose. During exhalation, the latex-free hose strikes the top and bottom of the plastic tube, which intermittently occludes flow and causes oscillations and positive expiratory pressure in the patient's airways. The mouthpiece has settings that can be adjusted to twist the tube and increase the size of the expiratory resistor. This can adjust the frequency, amplitude, and mean pressure. The cornet is gravity independent and can be used in any position.[2][3]

Types of Cornet[edit | edit source]

  1. RC-Cornet® [4]
  2. RC-Cornet® PLUS [5]- It is a further development of the RC-Cornet®. It has an integrated nebulizer port that helps to deliver medication and helps in effective mobilization of secretions and reduces treatment time.

3.RC-Cornet® PLUS NASALR [8] - This device works on two settings. The first setting is used with patients who have Eustachian tube disorders that lead to congestion of the nose. The second setting is used for patients with chronic sinusitis, and postnasal drip syndrome. It is also known to reduce hyperresponsiveness in bronchial asthma. [8] How to use : Place the RC-Cornet® PLUS NASAL in the right nostril and cover the left nostril with the index finger. Breathe in and breathe out completely about 5-10 times. Repeat the procedure with the left nostril. Positive pressure and vibrations are produced when the patient exhales through the nose which is then transmitted to the entire nasopharyngeal space and helps with mobilizing and removing secretions. This device also provides simultaneous inhalation therapy and improves drug delivery and reduces treatment duration.

4.RC-Cornet® PLUS Tracheo - Useful for patients who are tracheostomized. Helps to cough up thick secretions.


How to use[edit | edit source]


  • Any preferable starting position can be chosen as the cornet is independent of gravity.
  • The lips should firmly hold onto the mouthpiece.
  • Take a deep breath with your nose and blow out into the device with a forceful exhalation.
  • Ideally, the exhalation phase should last three to four times longer than the inhalation phase. A low-pitched harsh sound and vibration would be felt in the chest.
  • This should be performed about 10-15 times followed by a huff and cough to mobilize the secretion.
  • This cycle can be repeated for 10 to 15 minutes or 3 sets of 10-15 repetitions.
  • The mouthpiece can be twisted to increase the positive airway pressure and the vibration in the airways.[13][14]

Indications[edit | edit source]

Contraindications[edit | edit source]

No absolute contraindications to the use of PEP therapy have been reported.

Relative Contraindications :

References[edit | edit source]

  1. Ni Y, Ding L, Yu Y, Dai R, Chen H, Shi G. Oscillatory positive expiratory pressure treatment in lower respiratory tract infection. Experimental and therapeutic medicine. 2018 Oct 1;16(4):3241-8.
  2. 2.0 2.1 Muthukumar TS, Thekkinkattil MK. Effect of cornet device to clear the excess trachea bronchial secretions in a 45 year old right middle and lower lobe pneumonia patient-a case report. MOJ Yoga Physical Ther. 2016;1(1):1-3.
  3. 3.0 3.1 Van Fleet H, Dunn DK, McNinch NL, Volsko TA. Evaluation of functional characteristics of 4 oscillatory positive pressure devices in a simulated cystic fibrosis model. Respiratory Care. 2017 Apr 1;62(4):451-8.
  4. Cegla UH, Jost HJ, Harten A, Weber T, Wissmann S. Course of Severe COPD with and without Physiotherapy with the RC-Cornet (R). Pneumologie (Stuttgart, Germany). 2002 Jul 1;56(7):418-24.
  5. O'Neill K, O'Donnell AE, Bradley JM. Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis. Respirology. 2019 Mar;24(3):227-37.
  6. CEGLA Medizintechnik. PEP-Device RC-Cornet® PLUS. Available from:
  7. CEGLA Medizintechnik.RC-Cornet® PLUS - Application. Available from:
  8. 8.0 8.1 Cegla UH, Jost HJ, Harten A. Improvement of postnasal drip, dry cough, airway resistance and bronchial hyperreactivity in asthmatics treated with oscillating pep (RC-Cornet-N) of the nasopharynx. ATEMWEGS UND LUNGENKRANKHEITEN. 2003;29(9):428-36.
  9. CEGLA Medizintechnik. RC-Cornet® PLUS NASAL - Active principle. Available from:
  10. CEGLA Medizintechnik. Application respiratory therapy device RC-Cornet® PLUS NASAL. Available from:
  11. CEGLA Medizintechnik. RC-Cornet® PLUS TRACHEO - Respiratory therapy.
  12. CEGLA Medizintechnik. RC Cornet® (Basic Cornet) for mucous clearance and airway stabilization [HD]. Available from:
  13. 13.0 13.1 Prem V, Alaparthi GK. Comparison of acapella and rc-cornet for airway clearance in bronchiectasis-A pilot study. International Journal of Current Research and Review. 2011;3(11):138-48
  14. Vyas A, Alaparthi GK, Krishnan S, Acharya V. Comparison of quake and RC-Cornet for airway clearance in bronchiectasis: a randomized crossover trial. International Journal of Health Sciences and Research. 2012;2(6):20-7.
  15. 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 Sills JR. Airway Clearance Therapy.The Comprehensive Respiratory Therapist Exam Review. 6th ed. St. Louis, Missouri : Elsevier, 2016