University of Cincinnati College of Medicine pulmonologist, Dr. Ralph Panos talks about a new device that could help COPD patients breathe easier.
Interview conducted by Ivanhoe Broadcast News in 2023.
Tell me how you and your team got to this. What challenges were you seeing that you thought we can make this better?
PANOS: If there’s a disease that’s actually taking America’s breath away and it’s chronic obstructive pulmonary disease, known by its initials COPD. It affects between one and eight and one and 12 Americans throughout the country. We’re actually in the epicenter of COPD epidemic. Cincinnati is the center of the highest prevalence of obstructive lung disease in the United States. When I first came here over 20 years ago, I was originally going to study in a different disease process, but I was so overwhelmed by the number of cases of obstructive lung disease that we started doing some studies. What we found originally was that about 40 percent of veterans at the Cincinnati VA had obstructive lung disease, many of whom weren’t diagnosed. Then we did some other studies looking at the symptoms and the manifestations of COPD.
What treatments are there for COPD? Is it medication or what is?
PANOS: The main medication right now is medication usually inhalers could be corticosteroids, antibiotics, and then for some individuals, supplemental oxygen. We’ve come up with the first mechanical device. The treatment of obstructive lung disease.
For most patients with COPD is that medication is not part of those inhalers?
PANOS: Many patients have persistent symptoms and not all of the symptoms, especially breathlessness, are amenable to pharmacologic treatment. The main cause of breathlessness and COPD is something called air trapping or dynamic hyperinflation. What that is, is an inability to exhale all the air that one takes in. That’s especially manifests during exertion when one starts breathing a little bit faster and they can exhale all the air. That hyperinflation stretches the respiratory muscles, pushes down on the diaphragm and causes that sensation of breathlessness.
Talk to me about the device. How did you come to that challenge where you see that people still have that hyperinflation. How do you take that into something practical for people?
PANOS: Many of our patients with obstructive lung disease enter a program called pulmonary rehabilitation. In pulmonary rehab, they learned something called personal breathing, which is breathing out through pursed lips to create that back pressure. Unfortunately, that’s a technique that’s hard to do and it’s hard to replicate. We thought we were puzzling how best to help patients learn to do pursed lip breathing. Dr. Mohamad, and I came up with this device which makes it easier to do pursed lip breathing.
Essentially, if we saw you demonstrate it, but now if you could walk me through the steps, talking through how someone would use this to get the benefits.
PANOS: The device is small, handheld and around a lanyard that goes around the neck. To use it, it’s just simply placed in the mouth. One breathes in through the nose and then out through the device. That resistance to airflow creates the back pressure, which relieves the air trapping and dynamic hyperinflation.
That’s instead of doing this pursed lips?
PANOS: That’s in place of pursed lip breathing. It’s consistent with every breath is exactly the same. The resistance is exactly the same. It’s totally consistent. Patients are able to do it at rest or do it with exertion.
How quickly can a patient feel some relief after?
PANOS: It’s almost instantaneous. We’ve done studies where patients have done six-minute walks with the device and without the device. Within the six min of that walk, they noticed that improvement in their breathing and they’re able to do more with less breathlessness.
Talk to me about the process of going from, here’s this medical challenge. Now we’ve got a device that it’s going to work. Did you have direction?
PANOS: It’s been quite a journey. We initially started with finding the devices making them ourselves, testing them in various studies, making sure it was actually increasing the expiatory pressure. Then we went to the Venture Lab here at the University of Cincinnati, went through their course and were paired with entrepreneur in residence who helped get us started. We now have a start-up selling the devices.
Talk to me a little bit about where you’re selling. What response to this device?
PANOS: We’re selling online at this point. We have a website, PEP buddy.com, and anyone can order to their device and we will mail it to them. We’ve sold approximately 350 to 400 devices over the last four months and orders keep coming in. We’re hoping to increase our volume.
Do you mind if have asked what it retails for and does insurance cover?
PANOS: So far we haven’t gotten on to any insurance plans, but that’s that’s the goal. The cost is 25 dollars.
Did this have to go through? I know it’s different from drugs and devices to this need any FDA approval.
PANOS: We’re working through that. We’ve been told by the institutional review board here at the University of Cincinnati. It’s a low-risk device. We’re hoping for class one or approval by the FDA, but we’re in that process now.
What is the possible time frame?
PANOS: We’re hoping weeks to months, but not years.
Looking back and thinking now, how far you’ve come with this, is this something that you ever could have anticipated in your years?
PANOS: I never thought I’d be going down the startup venture trail, but it’s exciting. It’s been a lot of fun. To be honest though, the most exciting part of it is the feedback we’re getting from our patients and from people who are using their device, the feedback received during the study.
Is there anything that I didn’t ask you about the product or the process or about COPD that you would want people to know?
PANOS: One of the most surprising things that we’ve found, we did a study with 32 individuals with obstructive lung disease. Nearly three quarters felt less breathless when using the device. What was really surprising to us was nearly a third of those who had drops in their oxygen levels with exertion did not have those decreases in their oxygen level with using the device. PEP Buddy was able to improve oxygen levels in some patients with obstructive lung disease.
She came up with the name of your colleagues idea?
PANOS: it was a combination. PEP is actually positive expiatory pressure as well as PEP energy. So it’s PEP and it’s a buddy, it’s- it’s around your neck, it’s there to help you.
If you wouldn’t mind reading some comments, they’re just ringing.
PANOS: These are comments from our study, from individuals who participated. “I’m blown away by how much it helps my breathing when I use this device. My biggest positive about the device is that it retrained me on how to breathe properly in a more comfortable way while being active. I’ve never been able to breathe in through my nose and out through your mouth before.”
END OF INTERVIEW
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