The impact of facemask on patients with COPD: A systematic review and meta-analysis

Xuwen Chen; Changqing Zhang; Sani Ibrahim; Shunyu Tao; Xiaoli Xia; Yi Li; Caiyun Li; Feiyan Yue; Xinhua Wang; Shisan Bao; Jingchun Fan

doi:10.3389/fpubh.2022.1027521

The impact of facemask on patients with COPD: A systematic review and meta-analysis

Front Public Health. 2022 Nov 16:10:1027521. doi: 10.3389/fpubh.2022.1027521. eCollection 2022.

Authors

Xuwen Chen¹, Changqing Zhang², Sani Ibrahim¹, Shunyu Tao³, Xiaoli Xia⁴, Yi Li⁵, Caiyun Li¹, Feiyan Yue¹, Xinhua Wang¹, Shisan Bao¹, Jingchun Fan¹

Affiliations

¹ School of Public Health, Center for Laboratory and Simulation Training, Centre for Evidence-Based Medicine, Gansu University of Chinese Medicine, Lanzhou, China.
² Department of Radiology, Gansu Provincial People's Hospital, Lanzhou, China.
³ School of Public Health, The University of Sydney, Camperdown, NSW, Australia.
⁴ Department of Geriatrics, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China.
⁵ Department of Respiratory Cadres, Gansu Provincial People's Hospital, Lanzhou, China.

Abstract

Background: Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks on patients with COPD was unclear.

Methods: The current study undertakes a systematic review and meta-analysis of a comprehensive literature retrieval from six databases, based on the pre-determined eligibility criteria, irrespective of language. The risk of bias was assessed using an established instrument. We primarily focused on analyzing ETCO₂, SpO₂, and heart and respiratory rates, and also considered the impacts on physiological and exercise performance. A descriptive summary of the data and possible meta-analysis was performed. Forest plots were generated to pool estimates based on each of the study outcomes.

Results: Of the 3,751 publications considered, six publications were selected for a systematic review and two publications were included for meta-analysis, however, the quality of these six studies was relatively low overall. In the case of inactivity, the facemask wearing COPD cohort had higher respiratory rates than that of the non-facemask wearing cohort (MD = 1.00 and 95% CI 0.47-1.53, P < 0.05). There was no significant difference in ETCO₂ (MD = 0.10 and 95% CI -1.57-1.78, P > 0.05) and heart rate (MD = 0.40 and 95% CI -3.59-4.39, P > 0.05) nor SpO₂ (MD = -0.40 and 95% CI -0.84-0.04, P > 0.05) between the COPD patients with and without facemasks. Furthermore, it was observed that the only significant differences between the COPD patients with and without facemasks undertaking different activities were FEV1 (%) (MD = 3.84 and 95% CI 0.14-7.54, P < 0.05), FEV1/FVC (%) (MD = 3.25 and 95% CI 0.71-5.79, P < 0.05), and blood lactate (MD = -0.90 and 95% CI -1.73 to -0.07, P < 0.05).

Conclusion: Wearing facemasks decreased the exercise performance of patients with COPD, however, it had minimal impact on physiological indexes. Further investigations will be performed on the high-quality data from randomized control studies.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=326265, identifier: CRD42022326265.

Keywords: COVID-19; chronic obstructive pulmonary disease (COPD); facemasks; meta-analysis; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Humans
Masks
Personal Protective Equipment
Pulmonary Disease, Chronic Obstructive*
Sedentary Behavior