March 28, 2023

3 min read

Zafar reports being a co-owner of PEP Buddy, LLC. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

  • In more than 70% of patients with COPD, a positive expiratory pressure device improved exertional dyspnea.
  • The device mitigated desaturation in five of 14 patients with exertional desaturation.

Patients with COPD who experience breathlessness and exertional desaturation may see improvements with use of an oral positive expiratory device, according to study results published in Respiratory Care.

Muhammad Ahsan Zafar

“PEP buddy is an adjunct to current COPD therapies, such as inhalers and pulmonary rehabilitation,” Muhammad Ahsan Zafar, MD, co-creator of the device and associate professor in the department of pulmonary critical care and sleep medicine at the University of Cincinnati College of Medicine, told Healio. “It provides a tool for self-management and breathing re-training, in addition to reducing dyspnea and improving quality of life.”

Infographic showing that 71.8% of patients with COPD had exertional dyspnea improvement with the PEP Buddy.

Data were derived from Zafar MA, et al. Respir Care. 2023;doi:10.4187/respcare.10278.

In this study, Zafar and colleagues analyzed 32 patients (mean age, 66.6 years; 43% women) with moderate to severe COPD who had an FEV1 less than 80% predicted and a prior 6-minute walk test (6MWT) that showed exertional dyspnea or desaturation to see if PEP Buddy, a small oral positive expiratory pressure (PEP) device that generates 4 cm H2O to 10 cm H2O of expiratory pressure, could improve exertional dyspnea, desaturation and quality of life.

Through the Shortness of Breath Questionnaire (SOBQ; score range 1 to 100, lower is better), researchers found out baseline dyspnea (52.8 ± 25), and through the St. George Respiratory Questionnaire (score range 1 to 100, lower is better), they found out baseline quality of life (50.1 ± 15).

To assess PEP Buddy, researchers conducted one 6MWT with PEP Buddy and one 6MWT without it, and asked patients to use the device in their daily lives for 2 weeks.

After 2 weeks, researchers obtained new dyspnea and quality of life scores, as well as the patients’ level of device use.

Following this short-term period, researchers found that seven patients had a meaningful improvement in end Borg score (a decrease of 1 or more points) on the 6MWT, 11 patients had a meaningful decline in SOBQ (a decrease of at least 5 points) and five patients had a reduction in both measures, for a total of 23 (71.8%) patients classified as “dyspnea responders.”

“While most people had meaningful improvement with PEP buddy use, there are some that did not benefit from it, so the response may be different in different people,” Zafar told Healio.

Researchers observed that those with a dyspnea response had worse FEV1 (40.4% vs. 56.5%; P = .009) and FVC (68.5% vs. 82%; P = .03) than dyspnea nonresponders, but they showed more improvement after using PEP Buddy in SOBQ (–7.37 vs. 13.55; P = .001) and quality of life scores (–4.69 vs. 1.77; P = .03) than nonresponders.

Researchers noted no differences in 6MWT distance with and without use of PEP Buddy.

In terms of exertional desaturation (nadir oxygen saturation < 88%), 14 patients had decreased oxygen levels during the 6MWT without PEP Buddy. During the 6MWT with PEP Buddy, five of these patients (35.7%) mitigated desaturation with oxygen levels close to normal levels throughout the 6MWT.

“I have never seen such a response to oxygen levels with anything other than supplemental oxygen,” Zafar told Healio.

Those who mitigated desaturation had higher nadir oxygen saturation with use of PEP Buddy than the nine nonresponders (91.2% vs. 82.5%; P = .002).

When assessing how often patients used the device, Zafar said some patients reported that the device led to a decreased use of other breathing aids.

“A few patients reported less use of rescue inhalers,” he said. “They would sit down and use this device when feeling out of breath first, before using inhalers.”

Other benefits of the device reported by patients included breathing training/regulation, ease of use, pre-exertional use, faster recovery after exertion and less anxiety.

However, patients did report some limitations, such as restrictive pressure on peak exertion, saliva buildup and difficulty getting comfortable with the device.

Future studies will cover more factors over a longer period of time, Zafar told Healio.

“In the next steps, we would like to explore the long-term effects of PEP buddy on symptoms and quality of life for people with COPD, and its impact on emergency room visit rates, use of rescue inhalers and health care cost,” he said. “PEP buddy also seems like an attractive addition to pulmonary rehabilitation programs to help enhance early outcomes and potentially sustain the benefits of pulmonary rehabilitation longer.”

For more information:

Muhammad Zafar, MD, can be reached at [email protected].


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