Facemasks as a COVID-19 barrier: a window into the overlooked experience of chronic dyspnoea?

Lifting dyspnoea invisibility: COVID-19 face masks, the experience of breathing discomfort, and improved lung health perception – a French nationwide survey

“…Furthermore, face mask-related dyspnoea is likely to be the first encounter with dyspnoea for most people. It therefore has the potential to change the general public's perception of what it means to experience breathing difficulties [14], namely to improve dyspnoea visibility. Within this frame, we predicted that face mask-related dyspnoea would be described as very intense by healthy individuals despite the masks not representing a critical physical constraint.…”

“…We also predicted that patients with a chronic respiratory disease as well as healthy individuals with a family member treated for a chronic respiratory disease would experience more frequent and intense mask-related dyspnoea. Finally, we predicted that healthy individuals reporting mask-related dyspnoea would also report increased concern about their respiratory health and would report a better understanding of the experience lived by patients with chronic respiratory disease [14]. Using a methodology that has previously helped understand some aspects of the epidemiology and characteristics of dyspnoea in the general population [15][16][17], we tested the above hypotheses by conducting a cross-sectional survey in a sample demographically representative of the French adult population.…”

Impact of surgical mask on performance and cardiorespiratory responses to submaximal exercise in COVID-19 patients near hospital discharge: A randomized crossover trial

“… 22 In patients without significant dyspnoea at baseline such as in our cohort, wearing a facemask make patients suddenly aware of their own respiration, which can be unsettling. 23 However, post-effort, the blunting of multiple inconvenient sensations (mask humidity, hotness, etc) as well as the feeling of relief from effort cessation may have prevailed over dyspnoea sensation by distracting the patient's attention from their own respiration. Of note, the kinetic of change in dyspnoea and rate of perceived leg exercise was roughly similar between subgroups of participants discriminated by the levels of oxygen requirements during their hospitalization.…”

An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

“…larger endotracheal tube > 8.0) High risk of laryngeal injury both early and later, including paralysis, edema, stridor, and stenosis [ 61 , 62 , 96 ] Risk of disuse atrophy [ 116 ] Tracheostomy insertion Respiratory support, laryngopharyngeal sensory impairment due to prolonged cuff inflation & lack of airflow [ 61 , 62 ] Risk of secondary airway problems, for example, stenosis, vocal fold palsies, long-term tracheostomy [ 61 , 62 ] Patient complaints / concerns Complaints of swallowing difficulties Altered sensation, fatigue, weakness, breathlessness Complaints of persistent altered taste/smell & /or reflux & /or gastric issues Increase risk of nutrition issues secondary to reduced interest in food & reduced intake Disturbance in voice quality following infection High risk of laryngeal injury both early and later, including paralysis, edema, stridor, and stenosis [ 61 , 62 , 97 , 116 ] Risk of disuse atrophy [ 116 ] Vagus nerve impairment Signification associations between severity of dysphonia, dysphagia, and cough Dysphonic COVID-19 patients are more symptomatic than non-dysphonic individuals [ 97 ] Ongoing fatigue on discharge Reports of long-term fatigue for many. In those with dysphonia or dysphagia, this may have functional implications [ 92 – 94 ] Ongoing shortness of breath on discharge Incoordination of breathing–swallowing mechanism Occupational risk Required to talk for prolonged periods of time with face mask Stigma Chronic fatigue, anxiety, depression Known to lead to increase volume and increase risk of vocal pathology [ 117 ] Stigma associated with chronic cough [ 104 , 118 ] High levels of anxiety & depression in long COVID [ 104 ] ...…”