International Journal of Health Sciences & Research (www.ijhsr.org) 132 Vol.7; Issue: 11; November 2017 International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Positive Expiratory Pressure (PEP) Therapy in Patients with Diseases of the Pleura Dr. Humaira Ansari 1 , Dr. Shreya Dhake 2 , Dr. Shakeel Ahmed 3 1 Physiotherapist, Deccan Education Society’s Brijlal Jindal College of Physiotherapy, Pune 2 Associate Professor, Deccan Education Society’s Brijlal Jindal College of Physiotherapy, Fer gusson College Campus, Pune 411004 3 Graduate Assistant and PhD Scholar, Department of Physical Therapy, University of Florida Corresponding Author: Dr. Humaira Ansari ABSTRACT Background: Diseases of the pleura such as pleural effusion, pneumothorax, hemothorax or hydropneumothorax are characterized by collection of air or fluid in the pleural space and are managed by draining the pleural space using an intercostal drain. Physiotherapeutic interventions such as breathing exercises and postural drainage are used to reduce work of breathing and improve ventilation. However, there is no established evidence on the effects of positive expiratory pressure (PEP) therapy in such patients. Objectives: To assess the effectiveness of Positive Expiratory Pressure (PEP) therapy in patients with an intercostal drainage tube. Materials and Methods: A quasi experimental pre-test and post-test design was used for the study. Thirty subjects were selected and randomly divided into two groups of fifteen subjects each. One group was given conventional breathing exercises and the other group was given conventional therapy along with bottle PEP therapy twice a day for 5 days continuous days. Chest expansion at 2 nd , 4 th and 6 th intercostal space, dyspnoea at rest and on activity, SPO 2 i.e. oxygen saturation and respiratory rate were assessed prior to and after intervention. Results: Post PEP therapy there was improvement in respiratory rate, chest expansion at 2 nd & 4 th intercostal space, oxygen saturation, dyspnoea at rest and on activity. The mean difference of these parameters was statistically significant (p value<0.05). Conclusions: Positive Expiratory Pressure therapy along with conventional therapy is more effective than only conventional therapy on respiratory parameters in patients with intercostal drain. Keywords: Breathing exercises, Bottle Positive Expiratory Pressure, Conventional therapy, Intercostal drain, Physiotherapy INTRODUCTION The thoracic cavity is lined by the pleural membrane and the space between the layers of pleura contains pleural fluid. In diseases like pleural effusion, pneumothorax, hydropneumothorax there is collection of air or fluid in the pleural space. [1-3] Intercostal drain (ICD) is inserted to drain this fluid. This may include a water seal chamber, suction tube or gravity assisted drainage. The accumulation of fluid results in increased respiratory demands i.e. increased respiratory rate, decreased chest expansion and dyspnoea. [3] Physiotherapy exercises i.e. conventional breathing exercises are suggested as they maintain chest expansion, decrease dyspnoea and assist drainage of fluid. One school of thought suggests the use of only inspiratory exercises while the other suggests the use of both inspiratory as well as expiratory exercises. Positive Expiratory Pressure