Wearing a mask is the safest option during the COVID-19 pandemic. Noam Galai / Getty Images
  • A study found that even people with severe COPD can safely wear masks.
  • Experts emphasize that discomfort from masks shouldn’t turn into unfounded health worries.
  • The discomfort some people feel using a surgical mask can be due to anxiety or claustrophobia.

It can be inconvenient, uncomfortable, and a hassle if you forget to bring it with you shopping — but one thing a face mask is not, is dangerous.

That’s what researchers found in the most recent study looking at how face masks do (or do not) affect the ability to breathe, even in people with lung disease.

Researchers conducted the study, published earlier this month in the Annals of the American Thoracic Society, after a group of Florida residents challenged Florida’s mask-wearing mandate in June.

They argued that wearing a face covering could cause carbon dioxide (CO2) to build up and impair normal respiration.

“Everyone rebreathes a small amount of their own CO2 with each breath,” Minh Quang Nghi, DO, of Texas Health Physicians Group, who was not associated with the study, told Healthline. “Exhaled air, although containing some CO2, still contains a good amount of breathable air.”

He explained this is how rescue breathing is accomplished with CPR and that “a mask would not trap enough in the measured level of CO2 to cause a clinically significant change [poisoning].”

Protest-inspired research

“Several of my colleagues, including me, were seriously annoyed with people not using face masks for different reasons in the middle of a pandemic that was steadily spreading,” said Dr. Michael Campos, lead study author and pulmonologist at Miami VA Medical Center and the University of Miami Hospital and Clinics.

According to Campos, after Palm Beach County, Florida, residents protested mask mandates at a commissioner’s meeting, he looked up studies proving that surgical masks don’t impede breathing ability — and found none existed.

So he decided to prove it himself.

“I looked for documented evidence of safety and found none,” said Campos. “Since we know it is easy to prove that masks are safe, we did the study quickly in a couple of weeks.”

The study included 15 healthy participants and 15 military veterans with severe chronic obstructive pulmonary disease (COPD) with lung function below 50 percent.

They all wore face masks for 30 minutes and then walked for 6 minutes while wearing them. Each participant was then given a blood test, which showed that there were no changes in oxygen or CO2 levels.

“This paper does not add much to the medical community, as we all know they are safe and use them all day,” said Campos. “But it’s most important for the public and I’m happy media are picking up on this.”

Campos emphasized in the study that discomfort from masks shouldn’t turn into unfounded health worries.

“It is important to inform the public that the discomfort associated with mask use should not lead to unsubstantiated safety concerns as this may attenuate the application of a practice proven to improve public health,” he and his team wrote.

N95 versus surgical masks

This isn’t to say that mask use has absolutely no effect on breathing.

“Dyspnea, the feeling of shortness of breath, felt with masks by some is not synonymous of alterations in gas exchange. It likely occurs from restriction of airflow with the mask in particular when higher ventilation is needed (on exertion),” explained Campos in a statement.

Previous studies have shown that when wearing the N95 type of face mask, CO2 levels can also rise, but still remain within normal levels.

According to the study findings, the results agree with “prior observation on 20 healthy volunteers using a surgical mask for 1h [one hour] during moderate work rates,” that observed no “clinically significant” effects.

Discomfort is likely psychological

Campos’ research also finds that the discomfort some people feel using a mask is due to anxiety, claustrophobia, or even a neurological response to hotter than normal air touching the face, all of which can cause a “perceived difficulty in breathing.”

Mask use can still affect your breathing — by making you change your breathing patterns.

Christopher Ewing, a lung specialist based in Alberta, Canada, told Discover Magazine, “Most of us aren’t used to wearing face masks, and the sensation of having a mask on your face might make someone anxious or uncomfortable.”

Ewing explained that normally our breathing is regulated by the nervous system, but “it can also be influenced by the mind,” and that, “when we’re feeling discomfort, even subconsciously, it can change the way we breathe.”

He used the example of when we exhale and fog up our glasses, “we might compensate for that discomfort by not exhaling fully on our next breath.”

Breathing with a mask is a skill we need to practice, said Ewing. “It’s very similar to when you learn how to wear eyeglasses or use contacts; the more you practice, the more you get used to it.”

Proper mask use

“The key is to cover the nose and mouth,” said Nghi. “There should not be large gaps around the top, sides, or bottom.”

He also cautioned against touching the mask except around the ear loop after donning it to adjust, and if the mask becomes moist, it should be changed.

“Excess moisture reduces mask effectiveness,” he said, warning that, “If you touch the outside part of the filter of the mask, wash your hands.”

According to Nghi, the slight reduction and restriction of airflow can cause those with respiratory diseases, like severe asthma or emphysema, to feel a sensation of breathlessness. “However, those with active exacerbations would already feel worsened shortness of breath and should not be going out anyway,” he pointed out.

Asked what people can do to avoid discomfort breathing with a mask, Nghi recommended trying out different types of masks.

“There are different materials, construction, methods, number of layers and sizes,” he said. “Use different masks for different situations: exercising in a gym might require a lighter, thinner mask versus going grocery shopping or going to the office.”

Finally, he advised using trial and error to find the size and fit that provide optimum airflow to lessen feelings of discomfort.   

The bottom line

Recent protests against mask mandates inspired a pulmonologist to conduct research proving that masks don’t present any significant health risks.

The study found that even in patients with severe lung disease, mask use didn’t result in elevated levels of carbon dioxide in the blood.

Experts say that the discomfort some people experience may be a psychological reaction, and with practice, mask use can become more comfortable. They also say it may be necessary to experiment with different types of masks to find the most comfortable one for you.

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