Risk and impact of using mask on COPD patients with acute exacerbation during the COVID-19 outbreak: a retrospective study

Abstract

Background：Chronic Obstructive Pulmonary Disease（COPD) is an inflammatory airway disease characterized by the presence of expiratory flow limitation. Exacerbations of COPD are common acute events. During epidemic of COVID-19, concerns have been raised with regard to mask- using because of increasing respiratory resistance. In this study, we aimed to evaluate the relationship between the vital signs , inflammation index, hypercapnia, hypoxia and mask-using in AECOPD patients.Methods：This retrospective study was performed at a tertiary hospital, and enrolled 23 patients with AECOPD who were hospitalized three or more times in the respiratory department. Patients in Group C were hospitalized and used masks during the epidemic period of COVID-19. Patient’s data of the previous two hospitalizations from the medical record system divided into group A and group B according to the time sequence. Vital signs, inflammation index, artery blood gas from medical record system and questionnaires of three hospitalizations in the same patient were collected to perform paired test.Results: Surgical mask using increased the levels of PaCO2 (8.98mm Hg; p = 0.004), HCO3-act (4.1mmol/L; p =0.006), BE (3.01mmol/L; p =0.019) and systolic blood pressure (11.39mm Hg; p = 0.01) in patients with AECOPD compared to last hospitalization. Surgical mask using for 30 to 120 minutes is associated with hypercapnia. There were no significant differences observed between group B and group A without using mask in vital signs, inflammation index, and artery blood gas.Conclusions: In this study, we found that systolic blood pressures and PaCO2, HCO3-act, BE were significantly elevated in AECOPD patients using masks compared to the other groups without masks. In addition，the changes in PaCO2,HCO3-act,BE is closely related to serum chloride concentration. Therefore, it is need to increase awareness and understanding of the use of masks in patients with chronic cardiopulmonary diseases.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

“…These phenomena are responsible for a statistically significant increase in carbon dioxide (CO 2 ) blood content in mask wearers [ 19 , 20 ], on the one hand, measured transcutaneously via an increased PtcCO 2 value [ 15 , 17 , 19 , 21 , 22 ], on the other hand, via end-expiratory partial pressure of carbon dioxide (PETCO 2 ) [ 23 , 24 ] or, respectively, the arterial partial pressure of carbon dioxide (PaCO 2 ) [ 25 ].…”

“…In addition to the increase in the wearer’s blood carbon dioxide (CO 2 ) levels ( p < 0.05) [ 13 , 15 , 17 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], another consequence of masks that has often been experimentally proven is a statistically significant drop in blood oxygen saturation (SpO 2 ) ( p < 0.05) [ 18 , 19 , 21 , 23 , 29 , 30 , 31 , 32 , 33 , 34 ]. A drop in blood oxygen partial pressure (PaO 2 ) with the effect of an accompanying increase in heart rate ( p < 0.05) [ 15 , 23 , 29 , 30 , 34 ] as well as an increase in respiratory rate ( p < 0.05) [ 15 , 21 , 23 , 35 , 36 ] have been proven.…”

“…This is a reaction to pathological changes in the sense of an adaptation effect. A mask-induced drop in blood oxygen saturation value (SpO 2 ) [ 30 ] or the blood oxygen partial pressure (PaO 2 ) [ 34 ] can in turn additionally intensify subjective chest complaints [ 25 , 34 ].…”

“…A similar effect with the stimulation of high blood pressure, cardiac dysfunction and damage to blood vessels supplying the brain is suggested for slightly increased breathing rates over long periods [ 56 , 57 ]. Masks are responsible for the aforementioned physiological changes with rises in inhaled carbon dioxide [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], small sustained increases in heart rate [ 15 , 23 , 29 , 30 , 35 ] and mild but sustained increases in respiratory rates [ 15 , 21 , 23 , 34 , 36 ].…”

“…In another retrospective comparative study on COPD and surgical masks, examiners were able to demonstrate statistically an increase in arterial partial pressure of carbon dioxide (PaCO 2 ) of approximately +8 mmHg ( p < 0.005) and a concomitant mask-related increase in systolic blood pressure of +11 mmHg ( p < 0.02) [ 25 ]. This increase is relevant in hypertensive patients, but also in healthy people with borderline blood pressure values as pathological value range triggered by mask-wearing can be induced.…”