Impact of respiratory protective devices on respiration: Implications for panic vulnerability during the COVID-19 pandemic

Highlights • Panic-prone individuals often exhibit reduced tolerance when wearing RPDs. • Studies found that wearing RPDs may induce a real burden of respiratory effects. • Panic-prone individuals may be at higher risk of RPD-related respiratory discomfort. • Various strategies to decrease discomfort may overcome the risk of poor compliance.
Background The wearing of respiratory protective devices (RPDs) correctly and continually in situations where people are at risk of respiratory infections is crucial for infection prevention. Certain people are poorly compliant with RPDs due to RPD-related annoyance, including respiratory discomfort. We hypothesized that individuals vulnerable to panic attacks are included in this group. No published studies on this topic are available. The evidence for our hypothesis was reviewed in this study as a starting point for future research. Methods We selected a set of experimental studies that measured the respiratory physiological burden in RPD wearers through objective and validated methods. We conducted a bibliographic search of publications in the PubMed database (January 2000–May 2020) to identify representative studies that may be of interest for panic respiratory pathophysiology. Results Five studies were included. Wearing RPDs exerted significant respiratory effects, including increased breathing resistance, CO2 rebreathing due to CO2 accumulation in the RPD cavity, and decreased inhaled O2 concentration. We discussed the implications of these effects on the respiratory pathophysiology of panic. Limitations Most studies had a small sample size, with a preponderance of young participants. Different methodologies were used across the studies. Furthermore, differences in physical responses between wearing RPDs in experimental settings or daily life cannot be excluded. Conclusions This research supports the idea that panic-prone individuals may be at higher risk of respiratory discomfort when wearing RPDs, thereby reducing their tolerance for these devices. Strategies to decrease discomfort should be identified to overcome the risk of poor compliance.