A small positive-expiratory pressure (PEP) device that can be used on-demand shows promise for improving the lives of people with

chronic obstructive pulmonary disease
(COPD), according to a study.

Developed by researchers from the University of Cincinnati College of Medicine in Ohio, US, the PEP device is lightweight and easy to use. The device is as little as a whistle and can be strapped to a lanyard to be worn around the neck and held in the mouth when needed or during and after exertion, such as exercise.

Called the PEP Buddy, the device is designed to have a small profile, which is a huge advantage relative to currently available bulky and handheld PEP breathing devices, according to the developers of the device, Drs Muhammad Ahsan Zafar and Ralph Panos, both from the University of Cincinnati.

In pilot a study, Zafar and Panos, along with their colleagues, tested the efficacy of the device in 32 participants with COPD who had forced expiratory volume per 1 second (FEV1) less than 80% predicted and signs of exertional dyspnoea or exertional desaturation during a 6-min walk test.

All participants underwent a 6-min walk test under two conditions: with and without the device. Then, the device was taken home by the participants to use in their daily routines. A follow-up was conducted after 2 weeks to evaluate the participants’ shortness of breath and quality-of-life scores.

For 23 participants (73 percent), the use of the device led to significant improvements in shortness of breath (FEV1, p=0.009) and forced vital capacity (p=0.03). Additionally, among the 14 participants with lower oxygen levels, only five (36 percent) experienced exertional desaturation with the use of the device. [Respir Care 2023;68:408-412]

“Dr Panos and I both see patients with COPD, and it’s a huge population. Their life really changes when they have COPD. They were active individuals but now they’re debilitated and limited, so we wanted to come up with something easy that helps improve their life,” Zafar said in a statement.

People with COPD have tighter air tubes, which make it longer to get inhaled air out of the lungs with each breath, Zafar explained. Consequently, when these people breathe fast, such as during physical activities, air stays in the lungs. This event, called air stacking or “dynamic hyperinflation,” leads to lower oxygen levels and is the primary reason for breathlessness.

Because breathing gets difficult during physical activity, people with COPD often choose to avoid exertion, becoming less and less active and more isolated, Zafar noted.

“As a physician I feel gratified that we are providing something new that can actually improve people’s lives,” he said. “That’s where my passion is. [People with COPD] are really debilitated with not many tools in their hand to improve their symptoms right now. PEP Buddy will be one such tool.”

Moving forward in the research, the next step is to conduct a long-term study to evaluate the impact of the device on the use of rescue inhalers, emergency department visits, and long-term symptoms and functional capacity in people with COPD, according to Zafar.

Zafar and colleagues believe that PEP Buddy is a promising addition to pulmonary rehabilitation programs aimed at faster improvement and sustaining better outcomes. The researchers shared that they are also exploring other uses of PEP Buddy in healthcare.

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