Face masks as a COVID-19 barrier: a window into the neglected experience of chronic dyspnea?


The COVID-19 pandemic has resulted in widespread use of face masks around the world. Face masks help protect people who wear them and those around them from contamination, and they also protect against fear of contamination. Wearing a mask is however associated with a series of material constraints: you have to think about the mask, have it with you, pay for it, change it or wash it frequently. Face masks are also associated with marked sociological disadvantages, hindering verbal communication (eg, muffled voice, invisible lip movements) and hindering non-verbal communication by making facial expressions difficult to read. Face masks can also be uncomfortable to wear. Primarily, being mildly resistant to air flow and a possible source of carbon dioxide rebreathing, they change our relationship with our own breathing. We suddenly become aware of our breaths and many of us find it disturbing. What if there was a sociological advantage to this particular consequence of wearing protective masks? What if it could make us more aware of the plight of patients with chronic respiratory problems?

Usually, the continuous neuronal bombardment of respiratory afferents that our brain receives is completely shut down, and, once passed the test of our very first breath, breathing comes naturally and we are not consciously aware of it, even when it is. disturbed by light exercise or speech.

But disease-related changes to the respiratory system resulting from abnormalities in the lungs, heart, or neuromuscular structure can end this so-called respiratory bliss. These alterations can cause breathing that is faster, shallower, labored, noisy or associated with abnormal use of certain muscles. More importantly, they can lead to dyspnea, i.e. breathing becomes a conscious act (sensory dimension) and an emotionally disturbing act (affective dimension). This multidimensional negative respiratory experience, the felt intensity of which may be disconnected from the extent of the underlying respiratory abnormalities, is a symptom – a red flag. But beyond that, it’s a life-changing existential experience, with psychological, behavioral and social consequences. This is especially true when dyspnea cannot be improved by treatments to correct its responsible pathophysiologic abnormalities, a condition called chronic shortness of breath or persistent dyspnea. In such cases, the ubiquitous breath awareness becomes a permanent threat, a permanent reminder of impending death. The impact of dyspnea on the lives of sufferers is further compounded by the invisibility that unfortunately characterizes the experience. Even though observing acute dyspnea in others is associated with negative feelings, dyspnea is not only underdiagnosed and associated with late diagnosis, but also underestimated, undertreated, and often associated with deficiency. apparent empathy of others. This invisibility prevents access to appropriate care and poses a human rights problem. It is partly explained by the disconnection of the dyspneic experience lived by the patients from the respiratory measurements carried out by the doctors. Additionally, the experience of dyspnea, with the inherent sense of helplessness that accompanies it, is not universal, unlike pain and other common ailments that everyone has experienced and with which everyone can. easily understand. Not having lived with dyspnea likely limits the ability of others to empathize and empathize with patients, which probably explains in part the avoidance behaviors that are sometimes observed in people with dyspnea patients, and sometimes even among caregivers.

Patients are well aware of the invisibility of dyspnea and remarks such as, “Doctors should make these symptoms felt, especially dyspnea, so that they understand what patients are going through” are not uncommon. Yet experiential learning theory suggests that personal experience of dyspnea may be helpful in changing one’s perception of it. This has not been formally studied, but is supported by anecdotal evidence. Likewise, Robert Lansing and colleagues report the post-hoc verbatim of a healthy person undergoing an air-hunger-inducing experiment: “If I felt like I had to live my life like this, I would jump out the window. “. Subjected for the first time to a similar experience, one of us (AG), a respiratory intensivist, exclaimed that he “would never tell another [dyspnoeic] patient mechanically ventilated to calm down ”.

Thus, wearing a face mask to combat the circulation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) makes breathing a conscious experience that can be unsettling or oppressive. This dyspnea is mild at rest and is in no way comparable to the experiences of the patients. However, it can become disturbing enough – when going up stairs, talking while walking, in confined or crowded spaces, or in reaction to heightened emotional states – that people seek respiratory relief by removing their mask, at the cost of disturbing hygiene recommendations. . This amounts to regaining control, an option not available for dyspnea patients, and illustrates the truly dyspnogenic effect of face masks.

We submit that the respiratory discomfort induced by face masks could be viewed as a form of mass experiential learning that may lead large numbers of people to discover the neglected existential experience of dyspneic patients. We believe this provides a unique opportunity to raise awareness of what it means to be constantly aware and disturbed by your own breathing. This phenomenon could be taken advantage of by foundations and charities that promote lung health or by teams engaged in the field of disability studies as a communication tool on the dyspneic experience lived by patients with respiratory diseases. chronicles, in order, in the end, to be more successful. levels of understanding and empathy. In the meantime, let’s think about those patients when breathing through a mask bothers us.

TS reports personal expenses from AstraZeneca France, Boerhinger Ingelheim France, GSK France, TEVA France, Chiesi France, Lungpacer Inc, ADEP Assistance, personal expenses and non-financial support from Novartis France, and grants from Air Liquide Medical Systems , apart from the job submission. All other authors declare no competing interest.


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