PEP Buddy Co-Founder Ralph J. Panos, MD

PEP Buddy’s Co-Founder Explains Why COPD Patients Don’t Have to Live With Breathlessness

Among other roles, PEP Buddy Co-Founder Ralph J. Panos, MD is Executive Physician Director of the VA National TeleCritical Care Program. The TeleCritical Care Program involves the expansion of the VA TCC program to over 90 facilities and great than 1500 ICU beds throughout the VA.

On any given day, you can find Ralph working with the National TeleCC program staff and the East and West TCC Programs coordinating clinical expansion/programs and supportive administrative tasks. 

We sat down with Ralph to learn more about his background, what spurred him to get into this field, his recent research involving PEP Buddy—and much more.

Q: Tell us a little bit about yourself and your background. 

A: I obtained undergraduate and medical degrees from Brown University and I performed my internal medical residency and chief residency at the University of Maryland in Baltimore.

I completed pulmonary and critical care fellowships at the University of Colorado. I worked at the National Jewish Hospital, in Denver, Colorado, researching alveolar epithelial repair after lung injury and interstitial lung disease. My academic appointments include University of Colorado, Northwestern University, Penn State, and now the University of Cincinnati.

Previously, I directed a basic science laboratory using cell and molecular biologic techniques to evaluate lung injury and repair and discovered two key alveolar epithelial mitogens, keratinocyte growth factor (KGF)and hepatocyte growth factor/scatter factor. Pre-treatment with KGF prevented murine death after various forms of lung injury. 

More recently, my research is more clinical and translational centering on interstitial lung disease, chronic obstructive pulmonary disease, and TeleCritical Care. I directed the VISN 10/Cincinnati/East TeleCritical Care Program since its inception before moving to the National TeleCritical Care Program.

I have worked at the Cincinnati VAMC for nearly 20 years, holding positions as the Chief of the Pulmonary, Critical Care, and Sleep Medicine Section, Associate Chief of Staff for Research and Development, and Chief of Medicine. I served as Chair of the Board of the Cincinnati Education &Research for Veterans Foundation (CERV). I’m Professor of Medicine Emeritus, Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine at the University of Cincinnati College of Medicine. I am currently the Executive Physician Director, VA National TeleCritical Care Program. 

Q: What spurred you to get into this field?

A: When I first joined UC/Cincinnati VA I was struck by the numbers of patients with COPD (chronic obstructive pulmonary disease) and a little research showed that Cincinnati, Ohio was the epicenter of a COPD epidemic in the United States.

This realization led to the development of clinical COPD management programs at the VA and a series of COPD research projects, one of which was the study by Ahsan showing that dynamic hyperinflation was the best predictor of exertional desaturation in individuals with COPD.

With the realization that DH appeared to be a primary determinant of not only exertional breathlessness but also exertional desaturation, the next step was to see if mitigation of DH would improve shortness of breath and oxygen in individuals with COPD. That search led to a nearly decade long quest culminating in the development of the PEP Buddy device.

Previously, the major outpatient treatments for DH were medication inhalers, supplemental oxygen, pulmonary rehabilitation, and pursed lip breathing. PEP Buddy was developed as a treatment that was easier than pursed lip breathing but had similar physiologic effects in reducing DH.  Additionally, PEP Buddy has other profound beneficial effects including prevention of the fall in blood oxygen that occurs in some individuals with COPD. It also slows the rate of breathing.

Q: COPD patients can benefit greatly from PEP Buddy. To get more specific, how does PEP Buddy help COPD patients with certain things they’ve come to “just live with”?

A: Breathlessness, an inability to catch one’s breath, is the most common symptom of COPD.  This shortness of breath occurs most commonly with exertion, including activities of daily living such as bathing, dressing, walking to the mailbox, or while shopping.  

This breathlessness impairs an individual’s ability to exercise and perform essential daily functions. It diminishes their quality and enjoyment of life. Many individuals with COPD adapt to these limitations by doing less and “just live with” their shortness of breath.

This adjustment to COPD-associated breathlessness leads to a downward spiral—as a person does less, their physical capacity and stamina decline, leading them to do even less and their activity level declines even further. 

PEP Buddy has the potential to break through this barrier of breathlessness and arrest or even potentially reverse this spiral of declining activity. PEP Buddy can restore an individual’s enjoyment of life by increasing their ability to do more without the limitations of exertional breathlessness.  

By reducing the major cause of shortness of breath in COPD, Dynamic Hyperinflation (discussed by Dr. Zafar), PEP Buddy is able to reduce breathlessness and improve one’s ability to exercise and perform the activities of daily living leading to greater independence and enjoyment of life activities. 

Q: The team recently conducted research with PEP Buddy to determine how PEP Buddy affects breathlessness, activity levels, and oxygen levels in individuals with COPD. What did these findings suggest?

A: With the research staff at the University of Cincinnati College of Medicine, we recently studied the effectiveness of PEP Buddy in over 30 individuals with COPD.  

Each study participant walked on a level surface for 6 minutes with and without using a PEP Buddy Device.  The distance walked, their level of breathlessness immediately after walking and during recovery, and their blood oxygen levels were measured. 

Then, each person took a PEP Buddy device home, used it on their own for 2 weeks, and completed a short questionnaire.

These studies showed that two thirds of the participants had less breathlessness while walking with PEP Buddy. Additionally, their shortness of breath after walking resolved more quickly with PEP Buddy. 

Most importantly, in one third of the individuals whose blood oxygen levels decreased with walking, oxygen levels were sustained when they used PEP Buddy. Nearly all participants found PEP Buddy easy to use at home when they were doing their usual activities and many noted improved activity levels with less breathlessness. Some participants noted that they used their rescue inhalers less frequently.

Does Your Breathing Make Day-to-Day Activities Difficult?

PEP Buddy is a simple, innovative, and portable evidence-based medical device that reduces breathlessness so you can increase your activity level.

By breathing out through PEP Buddy, exhalation is prolonged, and your breathing rate slows. Developed by two lung doctors, PEP Buddy is scientifically proven to be safe and effective in clinical research studies. 

Find out which PEP Buddy is right for you.