Transforming Lives Through Better Breathing

The Quest for Better Health through Breathing

  • PEP Buddy co-founder Dr. Muhammad Ahsan Zafar, MD, MS recognized the potential opportunity to improve the quality of life for people with lung diseases. “I saw that being short of breath is one of the most crippling symptoms that is common in people with lung and heart diseases. It impacts them and their families in day-to-day life. I wanted to know if there was something that could improve their lives for the better.”

  • After joining University of Cincinnati/Cincinnati VA, PEP Buddy co-founder Dr. Ralph J. Panos, MD was struck by the number of people with COPD and its impact on their quality of life. Dr. Panos recognized that Cincinnati was the very epicenter of a COPD epidemic in the U.S. These realizations—nearly a decade ago—are part of what spurred Dr. Zafar and Dr. Panos to conduct research to better understand the underlying mechanisms of shortness of breath in people with COPD and develop interventions to reduce its impact on their lives.

Meet the Founders

  • M. Ahsan Zafar, MD, MSc

    M. Ahsan Zafar, MD, MSc: Associate Professor in Pulmonary & Critical Care and Quality Improvement Expert at the University of Cincinnati College of Medicine, Founder and CEO of Dr. SMART Team

  • Ralph J. Panos, MD

    Ralph J. Panos, MD: Professor Emeritus in Pulmonary & Critical Care at the University of Cincinnati College of Medicine. Executive Physician Director of the VA National Tele-Critical Care Program

Understanding Shortness of Breath

  • Focus on COPD

    Dr. Zafar and Dr. Panos’ research focused on what happens in peoples’ lungs when they have COPD: specifically, how airflow obstruction and lung anatomy and physiology affect breathing symptoms. For many people with COPD, small lung air tubes may collapse while breathing out during activities or with rapid, forceful breathing and they are not able to breathe all the air out and subsequently develop air stacking. This air stacking (or dynamic hyperinflation) is a major cause of breathlessness and disability among people with COPD.

  • Dynamic Hyperinflation

    “This air stacking is what we call 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 declines in oxygen levels,” explains Dr. Zafar. 

    Air stacking becomes more problematic when someone is doing activities or exercising. When a person starts to breathe faster and harder, she/he is not able to get all the air out with each breath. With each breath, some extra air is retained in her lungs and this buildup of air leads to air stacking.

  • Next Steps

    “With the realization that dynamic hyperinflation appeared to be a primary determinant of not only exertional breathlessness, but also exertional desaturation in COPD patients, our next step was to see if mitigation of dynamic hyperinflation 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 PEP Buddy,” adds Dr. Panos.

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A Decade-Long Quest Results in PEP Buddy

Dr. Panos and Dr. Zafar’s subsequent research focused on designing and studying a lightweight, handsfree, PEP or Positive Expiratory Pressure device: PEP Buddy. PEP Buddy provides a low level resistance that generates a gentle back pressure during exhalation, helping to keep open the small, flimsy air tubes and prevent them from collapsing by creating a type of pneumatic stent.

The device also prolongs the exhalation phase and reduces the breathing rate. “All these factors combine to mitigate dynamic hyperinflation and its subsequent effects on breathlessness and oxygen saturation levels during exertion,” explains Dr. Zafar.

Better Breathing & Better Quality of Life

After initial design success, the team then created different levels of PEP Buddy. “These different versions of PEP Buddy generate different levels of resistance and back pressures and can be used for different conditions and varying levels of disease severity,” says Dr. Zafar.

Subsequent studies have been conducted on the effectiveness of the PEP Buddy to help a variety of people find meaningful improvement in their shortness of breath. Today, PEP Buddy is being used by people with COPD and other obstructive lung diseases such as Excessive Dynamic Airway Collapse (EDAC). It is also useful for people looking to better manage anxiety and stress and those practicing mindfulness breathing exercises.

Restoring Enjoyment of Life

“We are extremely proud that PEP Buddy has the potential to break through this barrier of breathlessness and halt or even potentially reverse this spiral of declining activity”, adds Dr. Panos. 

“PEP Buddy may also restore an individual’s enjoyment of life by increasing their ability to do more without the limitations of exertional breathlessness. All in all, by reducing the major cause of shortness of breath in COPD—what we call dynamic hyperinflation—PEP Buddy is able to reduce breathlessness during activities of daily living leading to greater independence and enjoyment of life activities.”

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