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EMST in the SNF

5/26/2026

Expiratory muscle strength training (EMST) is an intervention using a pressure threshold device to improve the strength of respiratory muscles used in exhalation, which in turn can improve cough function (Pitts et al., 2009). Common devices available on the market include two manufactured by Aspire: the EMST-150 and EMST-75 Lite.

Accessing Devices in a SNF

In a SNF, obtaining an EMST device is often a barrier to the SLP implementing it as part of a plan of care.

  • DME Requirements: While the EMST-75 Lite is covered under Medicare Part B as Durable Medical Equipment (DME), the SNF is responsible for purchasing and providing all DME (wheelchairs, cushions, EMST-75 Lite, etc.) for patients living in the facility.
  • The Process: You cannot order an EMST-75 Lite through the Aspire website for your patient with Medicare Part B; the SNF must order it for them.
  • Medicare Part A: Similarly, when a patient is being seen under Medicare Part A, the SNF remains responsible for purchasing an EMST-75 Lite.

EMST-75 Lite vs. The Breather vs. Acapella

Significant research evidence for expiratory muscle strength training supports pressure threshold devices. It is important to distinguish these from other devices commonly seen in the clinical setting:

  • The Breather: This is a commonly seen device that appears similar to an EMST-75 Lite, however, the Breather is a resistive device. While cheaper, resistive devices do not presently have the same quantity or quality of evidence supporting them. The Breather functions by having the person blow through smaller and smaller straws. With resistive devices, there is no way to measure if the patient is putting in a certain amount of effort each rep—the patient could blow slowly one rep and quickly the next.
  • The Acapella: You may see these devices arrive with patients from the hospital, typically provided by a respiratory therapist. These combine positive airway pressure with vibrations to clear secretions from the airways. The Acapella is not a pressure threshold device.
  • Dr. James Curtis: Check the tutorial on his website.
  • Brooke Richardson: Look for continuing education with Brooke Richardson via Breathab.com or Medbridge.com.

A Note on Research: All companies cite research for their devices on their websites. I recommend you consider looking at the articles themselves, and importantly, pay attention to who funded each study.