Health effects of filtering facepiece respirators: Systematic review of pulmonary and cardiovascular effects

Abstract

Filtering facepiece respirators (FFRs) were introduced to protect the wearer by removing small particles from inspired air. FFRs are now also used to reduce the spread of transmissible agents from the wearer and are worn outside traditional healthcare and other workplaces. The COVID‐19 pandemic increased concerns about potential adverse effects on wearers. A PUBMED query retrieved articles through June 2022. Abstracts and selected full‐text articles were systematically reviewed by the authors. This article focuses upon cardiopulmonary physiologic effects (e.g., ventilation, CO 2 elimination, oxygen uptake, and respiratory control) with emphasis upon current and potential research methods as well as summarizing results. 1985 records were identified, of which only 26% were published before 2020. FFR effects on CO 2 elimination appear more likely to be significant than effects on oxygenation or cardiovascular function. While FFRs appear well tolerated by healthy persons, more research is needed for those with pulmonary or cardiac disorders, and for children. Many traditional pulmonary exercise study methods require special care when applied to filtering facepiece respirators. Studying additional parameters may explain the paradox of many subjective discomfort reports despite very limited physiologic effects.

Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects

“…Methods are described in detail in an earlier publication concerning ventilation, oxygenation, rebreathing/dead space, and the cardiovascular system 2 . References were retrieved by searches of PubMed, the bibliographic database of the US National Library of Medicine, if “N95,” “FFP2,” or “ FFP3” appeared anywhere in the entry including title, abstract, or keywords/MESH items (this also captured reports about KN95s).…”

“…This paper focuses on the effects on wearers of FFRs commonly used in the United States (N95), Europe (FFP2 and 3), and Asia (KN95). An earlier paper discussed the pulmonary and cardiovascular effects 2 . This report reviews and summarizes studies of effects on comfort, temperature, skin, psychology, and work performance.…”

“…Research should be systematically planned to prioritize the most important knowledge gaps. Traditional physiologic effects upon users of FFRs have been well studied in healthy (including pregnant) adults at rest and with exercise, and these mild effects are generally well‐tolerated 2,96 . The recent increase in publications has not been fully accompanied by concomitant improvement in understanding needed to guide medical screening, improved design, and use of alternative respiratory protective approaches.…”