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

Impact of respiratory protective devices on respiration: Implications for<br> panic vulnerability during the COVID-19 pandemic Background: The wearing of respiratory protective devices (RPDs) correctly and continually in situations where<br> people are at risk of respiratory infections is crucial for infection prevention. Certain people are poorly compliant<br> with RPDs due to RPD-related annoyance, including respiratory discomfort. We hypothesized that individuals<br> vulnerable to panic attacks are included in this group. No published studies on this topic are available. The<br> evidence for our hypothesis was reviewed in this study as a starting point for future research.<br> Methods: We selected a set of experimental studies that measured the respiratory physiological burden in RPD<br> wearers through objective and validated methods. We conducted a bibliographic search of publications in the<br> PubMed database (January 2000–May 2020) to identify representative studies that may be of interest for panic<br> respiratory pathophysiology.<br> Results: Five studies were included. Wearing RPDs exerted significant respiratory effects, including increased<br> breathing resistance, CO2 rebreathing due to CO2 accumulation in the RPD cavity, and decreased inhaled O2<br> concentration. We discussed the implications of these effects on the respiratory pathophysiology of panic.<br> Limitations: Most studies had a small sample size, with a preponderance of young participants. Different<br> methodologies were used across the studies. Furthermore, differences in physical responses between wearing<br> RPDs in experimental settings or daily life cannot be excluded.<br> Conclusions: This research supports the idea that panic-prone individuals may be at higher risk of respiratory<br> discomfort when wearing RPDs, thereby reducing their tolerance for these devices. Strategies to decrease discomfort<br> should be identified to overcome the risk of poor compliance.