How to Use an Aerobika: Breathing Steps & Settings

The Aerobika is a handheld oscillating positive expiratory pressure (OPEP) device that helps loosen and clear mucus from your airways by creating resistance and vibrations as you exhale through it. Using it correctly involves a specific breathing pattern: a deep inhale, a brief breath-hold, and a slow, controlled exhale through the device, repeated for a set number of breaths before performing huff coughs to bring mucus up. The settings dial on the device controls how much resistance you breathe against, and getting both the technique and the setting right matters more than most people realize.

How the Aerobika Works

When you exhale through the Aerobika’s mouthpiece, your breath passes through a one-way valve inside a cartridge that opens and closes rapidly. This creates two things at once: positive back-pressure that helps splint your airways open and push air behind mucus plugs, and oscillations (vibrations) that physically shake mucus loose from airway walls. The device can generate back-pressure up to about 30 cm H₂O at its highest setting, which is among the strongest in this category of devices.¹ The combination of pressure and vibration is what makes it more effective than simply coughing on your own: the pressure prevents smaller airways from collapsing during exhalation, while the oscillations thin and mobilize secretions so they can travel toward your mouth.

Step-by-Step Breathing Technique

The breathing pattern used with the Aerobika follows a consistent sequence across clinical studies and manufacturer guidance. Here is the process broken into its individual steps:

Sit upright: Good posture opens your chest and helps your lungs fill completely. Leaning forward slightly can also work.
Inhale deeply: Take a slow, full breath in through your nose or mouth, filling your lungs as much as you comfortably can. You are not breathing through the device on the inhale.
Hold your breath: Pause for two to three seconds. This allows air to distribute evenly throughout your lungs, including behind any mucus plugs.
Exhale through the device: Place the mouthpiece in your mouth, seal your lips tightly around it, and breathe out slowly and steadily. Your exhalation should last about three to four times longer than your inhalation. You should feel the device vibrating against your breath. Do not blow hard or fast; a controlled, moderately forceful exhalation is what you want.
Repeat for 10 to 20 breaths: Continue the inhale-hold-exhale cycle without removing the mouthpiece between breaths if possible.
Huff cough: After your set of breaths, remove the device and perform two to three huff coughs. A huff cough is a forced exhalation with an open mouth, as if you are fogging a mirror, but with more force from your belly. This moves loosened mucus up and out.

In a clinical trial where COPD patients used the device over 24 weeks, participants were instructed to follow exactly this pattern for about 10 minutes, twice daily, preferably after using their inhalers.² Using it after inhaled medications makes practical sense: the bronchodilator opens your airways first, and the Aerobika session then takes advantage of that wider airway diameter to push mucus out more effectively.

Why the Lip Seal and Exhalation Speed Matter So Much

Maintaining a tight seal on the mouthpiece is not just a minor detail. If air leaks around the sides of your mouth, the back-pressure drops, the oscillations weaken, and the device essentially stops doing its job. The same goes for exhaling too quickly: a short, forceful blast empties your lungs before the vibrations have time to work on mucus deeper in your airways. A longer, controlled exhalation keeps the pressure sustained and allows the oscillations to travel through more of your bronchial tree.

A study that monitored children with cystic fibrosis using OPEP devices found that none of the participants achieved the target therapeutic pressure ranges during exhalation, even after standardized instruction. The average pressure generated was only about 16 cm H₂O, and exhalation length averaged just 2.5 seconds, with wide variation among participants.³ The researchers concluded that the airway-clearing effects of the device were compromised by poor technique. This is worth keeping in mind whether you are an adult or helping a child use the device: the breathing pattern deserves real attention, not just going through the motions.

Understanding the Resistance Settings

The Aerobika has a dial or adjustment mechanism that lets you set the resistance to low, medium, or high. This controls how hard you have to push to exhale through the device, which in turn affects the amount of back-pressure and the strength of the oscillations.

The general guidance is to start on the lowest setting and increase gradually. A low setting is appropriate if you have very limited lung function, feel winded easily, or are new to the device. Medium and high settings are for people who can generate a stronger, longer exhalation and want more aggressive mucus clearance. Lab testing has shown that the Aerobika produces its most consistent oscillation amplitudes at the medium and high resistance settings, and that it outperformed several comparable devices at those levels.⁴ At low resistance, other devices in the same category sometimes produced stronger oscillations, while the Aerobika’s advantage became clearer as resistance increased.⁵

What this means practically is that if you are on the lowest setting and feel like the device is barely doing anything, that may be partly because the Aerobika’s design is optimized for stronger exhalation efforts. Conversely, jumping to a high setting when your lungs are not ready for it can make you feel breathless, lightheaded, or like you simply cannot complete a full exhalation. Your respiratory therapist or prescribing clinician should help you find the right starting point, but a reasonable self-check is this: you should be able to exhale steadily for the full three to four seconds without feeling like you are straining or running out of breath before the vibrations kick in.

How Exhalation Flow and Resistance Interact

One thing that catches people off guard is that the pressure and oscillation you feel from the device depend on both the resistance setting and how hard you blow. Bench testing of positive expiratory pressure devices, including the Aerobika, found that increasing your exhalation flow at a fixed resistance setting raised the average back-pressure and the peak pressure the device produced. Similarly, increasing the resistance at a fixed flow rate also raised the back-pressure.⁶ In plain terms, the Aerobika responds to both how hard you exhale and what dial setting you use, so the experience is not locked in by the setting alone.

This is why technique and setting need to work together. If you exhale gently on a high setting, you may not generate enough flow to trigger strong oscillations. If you exhale forcefully on a low setting, you may blow through the resistance too quickly, cutting your exhalation short. The sweet spot is a resistance setting that lets you maintain a steady, moderately forceful exhalation for the full duration, with the device producing a noticeable flutter or vibration the whole time. If you feel the vibrations start and stop, or only feel them for a brief moment, something is off with the pairing of your effort and the setting.

Using the Aerobika With a Nebulizer

Some people use the Aerobika connected to a nebulizer so they can inhale medication and perform OPEP therapy in one combined session, which can save time. The Aerobika is designed to attach to a breath-actuated nebulizer via an adapter port. A lab study tested this configuration and found that connecting a breath-actuated nebulizer to the Aerobika only marginally reduced drug delivery compared to using the nebulizer alone.⁷ That small reduction was statistically detectable but considered acceptable in practice. By contrast, combining the same nebulizer with a different OPEP device (the Acapella Duet) caused substantial medication losses. If you plan to combine nebulizer therapy with the Aerobika, check with your clinician and make sure you are using the correct adapter and a compatible nebulizer type.

Cleaning and Maintenance

The Aerobika can be disassembled for cleaning, and the manufacturer’s instructions call for washing it with warm soapy water after each use, then allowing it to air dry. The device is also top-rack dishwasher safe, which is one of its practical advantages over some other OPEP devices.

Real-world adherence to cleaning routines, however, is spotty. A study of children with cystic fibrosis who used PEP devices found that only about 42% of devices were cleaned after every use, and roughly one in five were never cleaned at all. Most patients who did clean their devices used soapy water and air-drying, which matched the manufacturer’s recommendations, and the average cleaning session took about 5 minutes. Some families attempted sterilization using boiling water, steam, or chemical solutions like Milton, but these were inconsistent and sometimes infrequent.⁸

Letting a device sit damp after use creates a warm, moist environment that encourages bacterial growth. This is especially risky for people with cystic fibrosis or other chronic lung conditions, where inhaling bacteria back into already-compromised airways can trigger infections. The two most important habits are: wash with soap and warm water after every use, and let every piece dry completely before reassembling or storing. Periodic sterilization (boiling for five minutes, or using a steam sterilizer) adds an extra layer of protection, but it does not replace daily washing.

What the Research Says About Outcomes

Several studies have looked at what happens when COPD patients use the Aerobika as part of their routine care, and the results are broadly encouraging. A cost-effectiveness analysis modeled the impact of Aerobika use on COPD exacerbations and estimated that when the device’s effect lasted at least 30 days, it prevented about six exacerbations per 100 patients per year and saved roughly $553 per patient. When the effect was assumed to extend beyond that conservative window, the benefit rose to about 21 fewer exacerbations per 100 patients per year, with savings of nearly $2,000 per patient.⁹ A Canadian analysis similarly found the device to be cost-saving: about $694 less in healthcare costs per patient per year compared to no OPEP therapy, with a small but measurable improvement in quality of life.¹⁰

A retrospective study comparing Aerobika users with Acapella users after hospital discharge found that Aerobika users were less likely to be rehospitalized within 30 days (about 14% vs. 20% for all-cause visits) and had fewer severe exacerbations over the following 12 months.¹¹ These are observational findings, not randomized trials, so they cannot prove the Aerobika caused the improvement by itself. People who are prescribed one device versus another may differ in ways that affect their outcomes. Still, the direction of the evidence is consistent: regular OPEP use appears to reduce the frequency and severity of flare-ups in people with chronic airway conditions.

Technique Problems in Children

If you are a parent helping a child use the Aerobika, the findings from the pediatric study mentioned earlier deserve special attention. Even after receiving standardized instruction, the children in that study generated pressures well below the therapeutic target, and their exhalation times were too short to be optimally effective.³ Children tend to exhale too quickly, may not seal their lips well around the mouthpiece, and often do not hold their breath long enough before exhaling.

A few strategies can help. First, start on the lowest resistance setting so the child does not feel like they are fighting the device. Second, practice the breathing pattern without the device first: breathe in, hold for a count of two, breathe out slowly for a count of six to eight. Making it a game, like “blow through a straw as slowly as you can,” can help younger children grasp the concept. Third, have your child demonstrate their technique in front of a respiratory therapist periodically, since bad habits develop gradually and are hard to self-correct. The device only works as well as the technique behind it.

Post-Surgical Use

The Aerobika is not only used for chronic lung conditions like COPD and cystic fibrosis. It is also prescribed after surgery, particularly thoracic and abdominal procedures, to prevent mucus buildup and reduce the risk of post-operative lung complications like pneumonia or atelectasis (partial lung collapse). A study comparing post-operative patients who used the Aerobika to those who used incentive spirometry alone found that rehospitalization rates within 30 days were significantly lower in the Aerobika group: about 14% compared to 23%. The Aerobika group also had shorter hospital stays when they were readmitted and substantially lower overall costs.¹² If you have been given the device after surgery, the breathing technique is the same, but you may need to start on a lower resistance setting and work your way up as you recover, since pain and reduced lung capacity after an operation can make it harder to generate a full exhalation.

When to Use It and How Often

There is no single universal prescription for Aerobika frequency. The 24-week COPD trial used twice daily for 10 minutes as its protocol, and that aligns with common clinical recommendations.² Some clinicians recommend three or even four times daily during an acute exacerbation or when mucus production is especially heavy, then scaling back to twice daily as maintenance. The timing relative to other treatments matters too. A common order is: bronchodilator inhaler first, then the Aerobika session, then any inhaled corticosteroids or other maintenance medications. The bronchodilator opens airways, the Aerobika clears mucus from those opened airways, and subsequent medications can then reach deeper into cleaner lung tissue.

Sessions do not have to take long. Ten to fifteen minutes per session, including the huff coughs, is a reasonable target for most adults. Doing shorter sessions more consistently is better than doing one long session and then skipping the next day. If you notice that mucus is coming up easily and your breathing feels relatively clear, you can keep sessions on the shorter side. On days when your chest feels congested or you are recovering from an infection, longer or more frequent sessions make sense.

Positions and Angles

Unlike some older airway clearance techniques that require specific postural drainage positions (lying on your side or tilted head-down), the Aerobika can be used while sitting upright. This is one of its main practical advantages for everyday use. However, if you have mucus that tends to pool in specific lobes of your lungs, your respiratory therapist may occasionally ask you to use the device while lying on one side or leaning forward to help gravity assist drainage from those areas. The device itself works in any orientation; the oscillation mechanism is not gravity-dependent the way some older devices are.

Sitting upright with your feet flat on the floor and your shoulders relaxed is the standard position. Avoid slouching, which compresses your lower lungs and reduces how fully you can inhale. If you are using the device in bed after surgery, raise the head of the bed to at least 45 degrees so your diaphragm has room to move.