Disclosures: The authors report no relevant financial disclosures.
December 20, 2021
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Most patients with asthma follow mask guidelines, encourage others to do the same

Disclosures: The authors report no relevant financial disclosures.
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Nearly all people with asthma said they wear masks to protect themselves and others against COVID-19, despite having some symptoms from doing so, according to survey results.

The researchers administered the online Face Mask Use in Adults with Asthma survey between November 2020 and February 2021, garnering 501 complete responses.

Among patients with asthma who wear masks to protect against COVID-19, 45.8% had problems breathing or increased coughing, 39% saw no changes in their asthma or asthma symptoms, and 2.3% experienced improved asthma or asthma symptoms.
Data were derived from Polivka BJ, et al. J Allergy Clin Immunol Pract. 2021;doi:10.1007/s10875-021-01065-9.

“We had previously surveyed adults with asthma to determine the impact of the pandemic on this vulnerable population,” study author Barbara J. Polivka, PhD, associate dean for research and professor at the University of Kansas School of Nursing, told Healio.

Barbara J. Polivka

“Once the mask mandates became the norm, we were curious about how adults with asthma were managing with masks. We were able to resurvey the over 500 participants who gave us permission to contact them again for additional studies,” Polivka said.

The 45 items on the survey included questions about how frequently participants wore masks in public places, their comfort levels with other people wearing masks in those settings, how long they wore a mask each day, what type of mask they wore and if they carried an inhaler while wearing a mask.

Participants additionally were asked to look at nine photos of people wearing masks — two of the photos showed people wearing masks properly —and identify the photos that showed how they wore masks themselves.

Also, 17 of the items addressed potential effects on a scale of 1 (none of the time) to 5 (all of the time) that participants experienced while wearing a mask, such as discomfort, wheezing and anxiety. Researchers totaled these responses for a Mask Effects Scale (MES), with higher scores in possible totals of 17 to 85 indicating more negative experiences.

Finally, the survey included COVID-19 diagnoses, the five-item Asthma Control Test (ACT) and three open-ended questions on factors in choosing a mask, experiences while wearing a mask and recommendations for others with asthma about masks.

Primarily, the participants were female (83.3%), white (89.2%), college educated (89.5%), residents of the United States (96.6), residents of urban (22.6%) or suburban (37.3%) areas and homeowners (55.1%). They also had well-controlled asthma (mean ACT score = 20.1 ± 4.2). Age ranged from 20 to 88 years (mean, 46.1 ± 15.2), 56% had a BMI < 30 and 88.4% reported having no symptoms of COVID-19 or having had a negative COVID-19 test.

According to the survey, results of which were published in The Journal of Allergy and Clinical Immunology: In Practice, 98.4% of the participants said they wore a mask in public spaces. A majority also said they were more comfortable when store employees (88%) and patrons (89.2%) also wore masks.

Also, 95.9% said they were extremely likely to wear a mask when they go to grocery stores and 93% when they to restaurants.

Of those who said they typically wear masks while in public places or at a gathering, 67.4% said they wear a mask for 3 hours or less a day. Also, 65.5% wore cloth masks with at least two layers, 44.4% wore surgical or procedural masks, and 91.1% identified at least one of the two photos depicting the proper way to wear a mask.

Plus, 54.8% of those who use an inhaler said they carry an inhaler most or all of the time when they wear a mask.

But masks can be uncomfortable, as while wearing a mask, participants reported discomfort (83.5%); warm or hot face (76.1%); trouble breathing (70.5%); itchy (64.7%), runny (52.9%) or stuffy (42.4%) nose; shortness of breath (59.8%); facial irritation or rash (46.6%); anxiety (42.5%); wheezing (32.3%); headache (30.3%); trouble concentrating (29.8%); itchy (23.2%) or watery (22.1%) eyes; drowsiness or dizziness (21.3%); and facial pain (20.9%).

The mean MES score was 28.6 ± 8.8, and participants with higher MES scores had significantly lower ACT scores (P < .001), wore masks longer (P = .005), had higher BMI (P = .009) and had lower educational levels (P < .001). There was no relationship between MES scores and age. Only ACT and hours worn per day significantly predicted MES scores (R2 = 0.19, F = 22.6, P < .001).

When choosing a mask, 67.3% said comfort or fit was the most important factor and 38.1% said effectiveness was most important, followed by 22.7% who said protection for themselves and for others was most important.

Whereas 45.8% said they had problems breathing or increased coughing while wearing a mask, 39% reported no changes in their asthma or asthma symptoms. In fact, 2.3% said they experienced improved asthma or asthma symptoms while wearing a mask, due to protection against the pollens or pollutants that trigger their asthma.

“We were pleasantly surprised at how many of our participants answered the three open-ended questions at the end of the study. Many of the recommendations were enlightening and surprising,” said Polivka. “Many noted the benefits and protection for themselves, but also for others.”

One-third of the respondents said other patients with asthma should “just wear it,” and 31.6% said others should ensure their masks are comfortable and fit properly. Additional suggestions included trying different masks to find one with the best fit without impeding breathing, having an inhaler available, maintaining social distancing and limiting exposure to others.

“One of the other common recommendations that participants noted was advocating for ‘mask breaks,’ safely taking a short break from mask wearing, and to take slow, deep breaths when wearing a mask,” Polivka said.

The researchers plan on following up with the participants to gauge their current perspectives on wearing masks.

“We are also interested in the long-term effects of COVID-19 on those with asthma who contracted COVID,” Polivka said.

For more information:

Barbara J. Polivka, PhD, can be reached at bpolivka@kumc.edu.