Experts insist on finding right fit, taking safe mask breaks to asthma patients

Mumbai: For 65-year-old Khar resident Madhuri Kanga, who is asthmatic for nearly seven years, wearing N95 mask in the deadly second wave of Covid-19 was a necessity to protect herself from the virus. However, the switch wasn’t easy. She found it discomforting and difficult to breathe during the initial few days. The mask often triggered headaches.

“For people with asthma, there is a kind of insecurity associated with breathing. Using a mask triggers that insecurity,” shared Kanga, adding, “In the pandemic I was able to gradually condition myself to use an N95 and settled for the design that fits me well.”

Masks help in trapping tiny respiratory droplets expelled into the air while breathing, talking, coughing and sneezing. Masks not only protect a person from coming in contact with such droplets, but they also prevent letting the droplets expelled by people out in the air. As the Covid-19 infection spread through these droplets, masks became a mainstay. But for patients with asthma, like Kanga, adapting to the use of masks has not been an easy journey.

“Patients who have not been taking proper medications and who don’t have their asthma in control, face the most difficulties adapting to masks,” said chest physician Dr Prashant Chhajed from Santacruz based Lung Care and Sleep Centre, who has been treating Kanga for the past few years. “Patients like Kanga, who have been on proper and regular medication adapt well,” he said.

According to Chhajed, the use of masks has benefited patients with upper airway allergies triggered by smog, dust particles and other pollutants, but those with advanced lung diseases have had to grapple with discomfort.

Researchers at the University of Illinois Chicago conducted an online survey of 501 adults with asthma and found that 84% experienced discomfort, and 75% reported trouble breathing or shortness of breath at least a little of the time while wearing a mask.

The researchers also found an association between poor asthma control and breathing issues after wearing a mask. “This finding is likely due to the fact that those with uncontrolled asthma are more likely to experience shortness of breath and trouble breathing even without a mask,” Dr Sharmilee Nyenhuis, a co-author of the study was quoted in a media release. The study was published in the January issue of The Journal of Allergy and Clinical Immunology: In Practice.

While a well fitted N95, or double masking is considered the most effective way of preventing Covid-19, some doctors allowed their asthma patients to use a simple cloth mask or a surgical mask to improve the wearability.

“It becomes a question of having some protection, instead of nothing at all,” said physician Dr Jalil Parker from Lilavati Hospital, who has had many of his asthma patients reaching out with frantic complaints about uneasiness due to masks. “Many of them had worsened allergic manifestations. At times, the fibres in the masks also cause irritation in the nasal mucosa (the tissue lining the nasal cavity) triggering sneezes,” he said, adding that some of his patients had to use the bronchodilators more frequently than before.

“I strictly asked my patients to avoid crowds or stepping out in case they could not adapt to wearing a mask. But cloth masks and surgical masks have been most convenient for them,” said Parkar.

The University of Illinois Chicago study team highlighted the need of taking mask breaks, as they found more symptoms associated with a longer duration of wearing masks.

“Mask breaks allow one with an opportunity to take large, deep breaths and do some breathing techniques,” Nyenhuis said. The team also recommended that employers should consider making accommodations for those with asthma to take safe mask breaks.