We sat down with Muhammad Ahsan Zafar, MD, MS-CTR, co-founder of PEP Buddy, to learn more about his background, how he got into the field of pulmonary and critical care, and what kinds of people can benefit from PEP Buddy, and why.
Q: Tell us a little bit about yourself and your background.
A: I obtained my medical degree from The Aga Khan University, Pakistan. I then came to the University of Cincinnati for my training (residency) in Internal Medicine and then sub-specialization (fellowship) in Pulmonary and Critical care medicine.
I then joined the University of Cincinnati faculty in the College of Medicine. During my first two years in this role, I obtained advanced training in ‘improvement science’ through a 2-year Quality Scholars Program at the James Anderson Center for Health systems’ excellence (Cincinnati Children’s). I have also completed a master’s in clinical and translational research.
I am co-founder of PEP Buddy, and I’m currently an Associate Professor of Medicine in the Division of Pulmonary and Critical Care at the University of Cincinnati. I served as the medical director of Pulmonary Rehabilitation center at University of Cincinnati for past 5 years.
Q: What spurred you to get into this field?
A: I was initially attracted to the field of pulmonary (lungs disease) and critical care (intensive care) due to the severity of illness and potential for improving the outcomes and experience of patients and their family members.
With experience, I saw that being short of breath (unable to catch breath) is one of the most crippling symptoms that is common in people with lung and heart diseases. This is what sparked my research interest in understanding the underlying mechanisms of shortness of breath in people with COPD (chronic obstructive pulmonary disease).
COPD is a common problem affecting 1 in 10 adults. As a director of Pulmonary Rehabilitation, I got to see how breathing problems can impact peoples’ lives and a little improvement can mean a lot to them and their families. It’s the difference between being able to play with grandkids, or keep your job, or going on vacation with your loved ones—and not being able to do so.
The idea about developing a light-weight and handsfree oral PEP device came after our research studies showed the role of air stacking (dynamic hyperinflation - DH) in causing breathlessness in people with COPD. PEP stands for positive expiratory pressure.
PEP Buddy can be used while resting, during activities and for faster recovery after activities. Based on user experiences and feedback, we have modified the design to make it more pragmatic and easier-to-use.
Q: You mentioned the initial idea for what is now called PEP Buddy initially came after your research studies on the role of air stacking. Can you share more about what those studies were about, and can you share the learnings you extracted from that research?
A: In people who have COPD, the small air tubes in the lungs become narrow and flimsy. They become tighter when the person is breathing out (exhaling) and it takes a longer time to get the inhaled air out of the lungs.
This becomes more problematic when they are doing activities or exercise. When they start breathing faster, they are not able to get all the air out with each breath. With each breath, some extra air is retained in the lungs. This air stacking is called dynamic hyperinflation. Dynamic hyperinflation is the primary mechanism of breathlessness in people with COPD.
Almost a decade ago, we observed in our research that dynamic hyperinflation not only causes breathlessness, it also is associated with drop in oxygen levels.
Our next two studies were to develop a lightweight, handsfree, PEP device. The idea of using a PEP device in this condition is to give a gentle back pressure during exhalation, which helps keep open the small flimsy air tubes and prevent them from collapsing. The device also prolongs the exhalation phase and reduces the breathing rate.
All these factors combined were to mitigate dynamic hyperinflation and its subsequent effects on breathlessness and oxygen saturation levels during exertion. We created different grades of PEP-buddy that generate different levels of back pressures.
In our most recent research, we studied the impact of using PEP buddy in people with COPD during activities and daily life. Two out of three people have meaningful improvement in their shortness of breath. Among people who have a drop in their oxygen levels when they are walking, PEP buddy prevents the drop in oxygen in 1 out of 3 people.
These results are very impressive! A small, easy-to-use device can make a big impact in someone’s life.
Q: Knowing how breathing is essential for life and breathing difficulty significantly impairs one’s sense of well-being, who else can benefit from using PEP buddy besides people with COPD?
A: The benefits of PEP Buddy go beyond its use in COPD or lung diseases. As I mentioned, PEP buddy use: prolongs the exhalation phase of the breath; it provides a gentle back pressure; it slows down the respiratory rate; and, it provides a point of focus for mindful breathing. Such breathing extend the use of PEP Buddy to other conditions and populations.
Just to name a few:
Those looking to better manage anxiety and stress: We know many people experience stress and anxiety on a day-to-day basis, and PEP Buddy can help them. There is a lot of available research that shows the benefit or mindful and slow breathing on reducing stress levels. PEP Buddy provides these features which helps reduce the levels of stress-hormones, lower heart rate, and lower blood pressure.
Those practicing mindfulness: Controlled breathing with prolonged exhalation is an essential component of mindfulness, meditation and/or yoga practices. However, it is hard to learn then techniques and even harder to master their routine use. PEP Buddy makes controlled and regulated breathing much easier and attainable.
People with ADHD: Controlled breathing can provide improved balance to the autonomic nervous system. In addition, PEP Buddy helps develop attention towards breathing by being a point of focus when it is being use. These features may helps individuals with ADHD become more attentive and relaxed.
Pregnant women: As pregnancy progresses, women experience breathing changes due to hormonal, physiological and physical changes. Their breathing becomes shallow and fast. This can be anxiety inducing. Pregnant women are often taught breathing techniques to help relax. We believe PEP Buddy provides all the features that can help moms practice relaxed breathing much easily and effectively.
Slow Down Your Breathing for Less Stress
“I am a huge fan of this device! It helped prolong expiration for me. It forced me to slow down my breathing.” —Exercise physiologist and yoga trainer
PEP Buddy is an easy-to-use, hands-free breathing device that relieves breathlessness. PEP Buddy can ease shortness of breath due to Chronic Obstructive Pulmonary Disease (COPD), emphysema, and other lung diseases. PEP Buddy is also used for mindfulness practices and to promote calm, slowed breathing to reduce stress and anxiety.
PEP Buddy was developed by two lung doctors and is scientifically proven to be safe and effective in clinical research studies.