How to Breathe Better With a Mask

A respiratory therapist offers tips to breathe easier this winter.

The idea of wearing a face mask through the long winter may not sound appealing. But as communities face record surges of COVID-19 cases, it’s crucial to wear your mask properly. It’s one of the most effective ways to prevent the spread of COVID-19.

Research published in October in the journal Nature Medicine projected that universal mask wearing would save almost 130,000 lives between mid-September 2020 and the end of February 2021. In addition, researchers who evaluated the effects of mask mandates in 15 states and the District of Columbia estimated that 230,000 to 450,000 COVID cases were possibly avoided between April 8 and May 22 because people wore masks, according to a study in the journal Health Affairs.

And there’s another good reason to cover up: Wearing a mask appears to be protective for the wearer as well as others, according to a scientific brief from the CDC.

“Until vaccines have been widely distributed and transmission of the virus has stalled, wearing a mask is our best defense,” says Cliff Dryden, MBA, RRT-NPS, director of respiratory therapy at NewYork-Presbyterian/Weill Cornell Medical Center.

Don’t assume a winter scarf can take the place of a well-fitting mask. Bulky scarves and other cold weather wear may shield you from the cold, but they are no match for COVID-19 and shouldn’t be worn in place of or under a mask. Scarves may be too loose or thin to thwart virus particles.

Wearing a face mask takes some getting used to, Dryden acknowledges. It can give the wearer the sensation of having to inhale or exhale harder.

“There’s definitely an impact,” Dryden says. “A face mask is designed to allow you to function, but you won’t be able to function at 100% capacity.” You may get winded more easily, he says.

But a mask has hidden benefits in the winter. “Cold air dries and cools the airway,” Dryden says. “However, wearing a mask contains the warm, exhaled breath and may serve to help combat the effects of winter.”

Dryden suggests the following to make masks easier to tolerate:

Take time to get accustomed to it.
It’s normal to feel claustrophobic or even panicky when breathing feels difficult. “But over time you get used to it,” he says. If your breathing feels restricted, open your mouth and take several long deep breaths until you catch your breath.

When you can, take a mask break.
Find a space without people, remove your mask, and breathe normally for a few minutes before donning it again, Dryden suggests.

Don’t slouch.
At the same time, make sure you aren’t obstructing your breathing with behaviors like slouching. “Good posture helps the lungs expand,” Dryden says. “And since sitting can make it more difficult to fill the lungs, just standing and taking a deep breath does wonders.”

Cliff Dryden, MBA, RRT-NPS, director of respiratory therapy at NewYork-Presbyterian/Weill Cornell Medical Center.

Lower the intensity and length of workouts.
People who live by their daily runs or like to bike around town face additional challenges. “If you’re exerting yourself or exercising, your respiration and heart rate speed up and your temperature rises,” Dryden says. “Wearing a mask intensifies all of that.”

The solution: Accept the new normal. “We need to adopt the mindset that we can’t function the way we usually do,” he says. “You can still get in some exercise but at a slower clip.”

Dryden suggests taking the intensity of exercise down a notch and breaking it up into small chunks. “If you take breaks in between to hydrate, and then get right back to your workout, you can still exercise, but in an effective, responsible way,” he says.

A cloth mask may be preferable for outdoor workouts. “A medical mask is very hard to exercise with outdoors,” he says. “Once you start to sweat, it’s likely to break apart.” This may be as much a problem in winter as summer as your body must exert extra energy to stay warm. So be sure to hydrate!

Replace masks if they get wet.
Whether due to moisture from your breath or snow or rain, soggy masks are less effective. Keep spares in your pocket or bag, and either toss medical masks or change the cloth ones when they get wet.

“Everyone needs to wear one to help stop the spread of the virus.”

— Cliff Dryden

Don’t forget the kids.
It’s important for children to mask up too. “Children may be asymptomatic but still able to spread the virus,” Dryden says. Even though there are fewer cases of children becoming sick from COVID-19, some children who had COVID-19 or were exposed to the coronavirus have come down with multisystem inflammatory syndrome, a rare constellation of serious symptoms that may require treatment in the intensive care unit.

The Centers for Disease Control and Prevention recommends that children over age 2 wear a mask. Though that’s easier said than done, Dryden notes, it helps if the children understand why it’s important. “If children are able to comprehend why they need a mask, that’s the biggest driver for how compliant they are,” he says. Having an open conversation with kids about COVID can make a big difference.

If small children are wearing masks, parents need to adjust the fit carefully. “You’re looking for that Goldilocks ‘just-right’ fit,” Dryden says. “If the mask is too tight, pressure injuries are more likely to happen because their skin is easier to break down.”

Monitor children closely and make sure they have adequate breaks from the mask and are drinking plenty of fluids.

Be prepared for disease flare-ups.
People with serious breathing problems like asthma and other respiratory conditions may find that wearing a face mask makes symptoms worse. Plus, the cold air of winter can be an irritant. Although wearing a mask warms the air around your face somewhat before you inhale, bitterly cold temperatures can still lead to breathing problems.

“People with asthma need to keep their peak flow meter and bronchodilators with them in case they have an attack,” Dryden says. “I advise them to try to stay more aware of their breathing while wearing a mask.”

While some people have a higher tolerance and can function better than others when wearing a mask, “everyone needs to wear one to help stop the spread of the virus,” he says.

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