The importance of comfort in respiratory protective devices

Study conducted in collaboration with Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico.

Particle filtering facemasks (FFP) are the most commonly used personal protective equipment (PPE), particularly by healthcare workers. The purpose of a face mask is not only to protect the wearer from particles, droplets and aerosols, but also to prevent the spread of aerosol-borne viruses. There are 3 types of masks, according to their performance in filtering particles: FFP1 (> 80%), FFP2 (> 94%) and FFP3 (> 99%).

It is well known that healthcare workers have to wear these devices for many hours during their daily work activities and usually wear FFP2 face masks due to their high protection for both the user and others in the user's vicinity. However, very often face masks are perceived as uncomfortable and can cause difficulties in nasal breathing.

It has been observed that people who regularly use FFP2 or FFP3 masks may develop a new form of 'irritant rhinitis'. This is characterised by a strong inflammatory response in the nasal mucosa, with increased mast cell activation and IgE production, and a significant accumulation of polypropylene fibres (the main material composing the masks), resulting in worsening of nasal breathing and endoscopic rhinosinus findings.

Nasal obstruction can often cause difficulty in maintaining concentration and lead to a decline in work performance. Usually, these symptoms tend to disappear after three days without wearing the mask. However, wearing FFP face masks can be essential to protect ourselves and others.

BLS and the important collaboration with universities

BLS has always collaborated with a number of Italian universities to develop new and innovative projects, aware of the importance of collaboration between the academic and professional worlds. In recent years, in fact, BLS has carried out a study, in collaboration with the Campus Biomedico in Rome, on the discomfort caused by the prolonged use of masks.

Over a period of four months, healthcare workers at the Policlinico Universitario Campus Bio-Medico, including doctors and nurses, aged between 18 and 65, employed in operating theatres and outpatient activities, were asked to wear FFP2/N95 masks for the first seven days and FFP2/BLS 502 'high breathability' masks for the next seven days during their daily work activities. The study was approved by the Ethics Committee of the Fondazione Policlinico Universitario Campus Bio-Medico, as per the OS-FFP protocol.

At the end of the seven days of use of both masks, participants were assessed in terms of nasal cavity symptoms (oedema, irritation, secretion and crusting of the nasal mucosa), using a 3-point scale (0=none, 1=slight, 2=moderate, 3=severe). Each participant also completed a questionnaire on any discomfort experienced from the prolonged use of each mask (humidity, heat, respiratory resistance, itching, tightness, saltiness, feeling of inadequacy, odour, fatigue) and a questionnaire on nasal respiratory symptoms (nasal itching, nasal obstruction, rhinorrhoea, sneezing), using a visual analogue scale (1=none to 10=very much), reporting the data in a daily diary for the duration of each trial.

Results

When comparing the data from the two periods, better data were observed after seven days with the FFP2/BLS 502 mask compared to seven days with the FFP2/N95 mask, finding statistically significant differences for the following variables:

Results of the nasal cavity assessment in relation to the use of an FFP2/N95 mask (FFP2) compared to the use of an FFP2/BLS 502 mask (BLS 502) on a 3-point scale (0=none, 1=slight, 2=moderate and 3=severe).

Results of the questionnaire on discomfort in relation to the use of an FFP2/N95 (FFP2) mask compared to an FFP2/BLS 502 (BLS 502) mask on a scale of 0 (no discomfort) to 10 (maximum discomfort), represented as a mean.

Questionnaire results on nasal respiratory symptoms in relation to the use of an FFP2/N95 (FFP2) mask compared to the use of an FFP2/BLS 502 (BLS 502) mask on a scale of 0 to 10, represented as mean.

Furthermore, better results, although not statistically significant, were obtained for the BLS 502 mask in terms of sneezing and nasal itching.

The healthcare workers included in the study particularly appreciated the difference between the common FFP2 masks and the FFP2/BLS 502 masks in terms of breathability and reduced discomfort during work shifts.

Conclusions

Due to its design, which adapts to different face shapes and sizes, and its low breathing resistance, the FFP2/BLS 502 mask appears to be more comfortable to wear than a common FFP2/N95 mask. This is confirmed by the better results obtained in the nasal cavity assessment, the discomfort questionnaire and the nasal respiratory symptoms questionnaire.

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