With input from Dr Monica Vasudev

1102:  Masks and asthma patients

1. Exempting respiratory patients from compulsory face mask regulations cannot be medically justified, and doing so would place this already susceptible population at greater risk for COVID-19.
2. Beginning in May, the Spanish government made face masks mandatory in open- and closed-space public places; however, it exempted people with respiratory problems, or those who cannot wear masks for other health reasons.
3. The European Respiratory Society (ERS) committee suggested that there is no evidence to state that masks harm anyone, including those with asthma, chronic obstructive pulmonary disease (COPD), or other respiratory diseases.
4. This exemption is not evidence-based, and it may be associated with increased risk of personal infection to the estimated 544.9 million people globally suffering a chronic respiratory disease [Joan Soriano, MD, PhD, of Madrids Hospital La Princesa in European Respiratory Journal research letter].
5. In a study from the U.S., published in the Annals of the American Thoracic Society, Michael Campos, MD, of the University of Miami and Miami VA Medical Center, and colleagues assessed exhaled carbon dioxide levels in healthy volunteers and patients with COPD, and noted slight difference in exhaled CO2 when masks were and were not worn. Among COPD patients with severe disease performing routine 6-minute walk (6MW) tests to determine their need for supplemental oxygen, wearing a surgical mask was not shown to be associated with greater CO2 retention or other significant changes in gas exchange.
6. There were 15 healthy volunteer physicians in the study, without lung conditions (median age 31.3 years, 60% men), and 15 U.S. veterans with severe COPD (median age 71.6, FEV1 44.0% ± 22.2%, all men). Baseline measures were performed on room air without a mask followed by continuous monitoring wearing a mask. This was followed by 6MW tests wearing surgical masks.
7. Among the COPD patients at 5 and 30 minutes, there appeared to be no clinically significant changes in end-tidal CO2 and oxygen saturation at any point in the at-rest measures. During the 6MW tests, oxygenation decreased and two participants needed oxygen, but the gas exchange measures on average didnt exhibit any major changes. There was no significant effect on CO2 retention.
8. Investigators do not recommend the use of N95 masks for patients with respiratory disease. The use of surgical masks or cloth masks with at least two layers of cloth should be encouraged.
9. Having asthma, COPD, and other chronic respiratory diseases should not hinder mask use unless the individual is having active acute respiratory distress. In such a scenario, going out in public is not advised.
10. Patients with respiratory conditions must wear face masks in public spaces where social distancing cannot be practiced. 

[Excerpts from Medpage Today]