BACKGROUND: Chronic obstructive lung disease is diverse and complex, exhibiting pulmonary and systematic symptoms that interrupt the patients' daily activities and sleep. The most frequent source of these symptoms is air stacking, which can be lessened by positive expiratory pressure Buddy, a simple and affordable device. AIM: This study aimed to assess the impact of positive expiratory pressure Buddy during exercise on pulmonary function, functional performance, and sleep quality among those patients. DESIGN: Randomized controlled study. SETTINGS: Faculty of Physical Therapy, Cairo University, Outpatient Clinic. POPULATION: Sixty patients with moderate-to-severe chronic obstructive lung disease, aged 55 to 65. METHODS: The participants were allocated evenly into two groups: the experimental group, which used the positive expiratory pressure Buddy while doing the aerobic exercise, and the control group, which did the same aerobic training without using the PEP Buddy. Spirometry (forced expiratory volume in 1 second and forced expiratory volume in 1 second/forced vital capacity ratio), dyspnea, a six-minute walk test distance, sleep quality, and quality of life (St. George Respiratory Questionnaire) were used to evaluate the patients both before and after the study's eight-week timeframe. RESULTS: The experimental group showed higher significant improvements in all assessed parameters than the control group after eight weeks of intervention (p < 0.001). CONCLUSIONS: When combined with a regular exercise regimen, positive expiratory pressure Buddy is an extremely adherence intervention that improves sleep, exercise capacity, pulmonary function, and general quality of life. Thus, it can be considered an excellent choice for patients receiving at-home treatment.

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