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Introduction
Exertional dyspnea occurs in 80% of individuals with COPD. As COPD’s most common symptom, exertional dyspnea contributes to a downward spiral of deconditioning, social isolation, and inactivity.1,2 Dynamic hyperinflation is a primary mechanism of exertional dyspnea in COPD and affects 80% of patients.3 Dynamic hyperinflation develops due to expiratory air flow limitation, especially with the faster breathing frequency and shorter exhalation time that occur during exertion.3,4 Dynamic hyperinflation also correlates with exertional desaturation.5,6 Altered alveolar ventilation caused by dynamic hyperinflation may produce ventilation-perfusion derangements contributing to exertional desaturation in COPD. Application of positive expiratory pressure (PEP)–generating techniques, like pursed-lip breathing or use of PEP devices, may mitigate dynamic hyperinflation and its consequences.7-8 Pursed-lip breathing is frequently taught to patients but may be difficult to perform consistently, and the generated PEP can be variable.9,10
We designed a small, hands-free, oral PEP device (PEP Buddy, patent pending) that generates PEP through air flow resistance applied at the mouth.11 It is held by the lips, released by opening the mouth, and attached to a neck lanyard that provides easy continuous access. The user inhales through the nose and exhales through the mouth while making a seal around the device with the lips. This device generates PEP, prolongs exhalation, reduces breathing frequency, and provides a point of focus for concentration. For this study, we used level 1 (resting PEP 4 cm H2O, exertional PEP 7 cm H2O, 20% breathing frequency reduction) and level 2 (resting PEP 7 cm H2O, exertional PEP 10 cm H2O, 45% breathing frequency reduction) devices.
In this pilot study, we investigated the effect of PEP Buddy on exertional dyspnea, exertional desaturation, and quality of life …
Correspondence: Muhammad Ahsan Zafar MD MCTR, Pulmonary and Critical Care Medicine, University of Cincinnati, 231 Albert Sabin Way, MSB Room 6053, Mail Location 0564, Cincinnati, OH 45267. E-mail: zafarmd{at}ucmail.uc.edu
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