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Lifting dyspnoea invisibility: COVID-19 face masks, the experience of breathing discomfort, and improved lung health perception – a French nationwide survey

Laure Serresse, Noémie Simon-Tillaux, Maxens Decavèle, Frederick Gay, Nathalie Nion, Sophie Lavault, Antoine Guerder, Antoine Châtelet, Frédéric Dabi, Alexandre Demoule, Capucine Morélot-Panzini, Caroline Moricot, Thomas Similowski
European Respiratory Journal 2022 59: 2101459; DOI: 10.1183/13993003.01459-2021
Laure Serresse
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Unité Mobile de Soins Palliatifs, Paris, France
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
12Co-first authors
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Noémie Simon-Tillaux
3AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département de Santé Publique, Paris, France
4Sorbonne Université, INSERM, UMRS 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
12Co-first authors
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Maxens Decavèle
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
5AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation, Département R3S, Paris, France
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Frederick Gay
6AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Laboratoire de Parasitologie-Mycologie, Paris, France
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Nathalie Nion
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
7AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
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Sophie Lavault
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
8AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
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Antoine Guerder
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
9AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Soins de Suite et de Réadaptation Respiratoire, Département R3S, Paris, France
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Antoine Châtelet
10Institut Français d'Opinion Publique (IFOP), Paris, France
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Frédéric Dabi
10Institut Français d'Opinion Publique (IFOP), Paris, France
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Alexandre Demoule
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
7AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
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Capucine Morélot-Panzini
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
8AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Département R3S, Paris, France
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Caroline Moricot
11Université Paris I Panthéon Sorbonne, Département de Sociologie & EA 2483 Centre d'Etude des Techniques, des Connaissances et des Pratiques (CETCOPRA), Paris, France
13Co-last authors
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Thomas Similowski
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
7AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
13Co-last authors
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  • For correspondence: thomas.similowski@upmc.fr
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  • FIGURE 1
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    FIGURE 1

    Distribution of the study subpopulations.

  • FIGURE 2
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    FIGURE 2

    Textual analysis of the respondents’ answers to the question “when you think about difficulties caused by wearing a face mask, which three words come to mind?”. Following lemmatisation of the verbatim responses, correspondence factorial analysis and descendent hierarchical classification identified three semantic classes. Class 1 had a dominant “respiratory” connotation, class 2 had a dominant “bothering” connotation and class 3 had a “positive” connotation (words with a respiratory connotation appear in bold). Class 1 and class 2 were significantly associated with reporting face mask-related dyspnoea at rest (Chi-squared test), whereas class 3 was significantly associated with not reporting face mask-related dyspnoea at rest (Chi-squared test).

  • FIGURE 3
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    FIGURE 3

    Frequency of mask-related dyspnoea. a) Comparison of respiratory healthy and respiratory disease populations (answer no or yes, respectively, to “treated for chronic respiratory disease or congestive heart failure” question). b) Comparison of respiratory healthy (RH)-family+ and RH-family− populations (answer no or yes, respectively, to “close relatives treated for chronic respiratory disease or congestive heart failure” question). Note that during intense effort, 55.5% of the respondents reported never wearing a mask; among the 44.5% who wore a mask during intense effort, 59.0% reported mask-related dyspnoea. Horizontal bars represent the mean value in the whole study sample. *: p<0.05; **: p<0.01; ***: p<0.001.

  • FIGURE 4
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    FIGURE 4

    Variables independently associated with reporting a) mask-related dyspnoea at rest or during moderate effort, and dyspnoea intensity b) at rest or c) during moderate effort, according to multivariate analysis. a) Relative being treated for respiratory disease p=0.008, facial mask as protection for others p=0.002, removing face mask p<0.001; b) best sensory descriptor p<0.001; c) age p=0.041, smoking p=0.041, removing face mask p<0.001, best sensory descriptor p<0.001, best affective descriptor p=0.044.

Tables

  • Figures
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  • TABLE 1

    Description of the global study population and of the “respiratory healthy” and “respiratory disease” subgroups

    Whole populationRespiratory healthy group#Respiratory disease group¶p-value+
    Participants1012860 (85)152 (15)
    Female517 (51.1)457 (53.1)60 (39.5)0.012
    Age years50.00 (34.00–65.00)49.00 (33.00–62.00)57.50 (44.00–71.00)<0.001
    Socio-professional status0.014
     Farm workers7 (0.7)5 (0.6)2 (1.3)
     Artisans or shopkeepers33 (3.3)31 (3.6)2 (1.3)
     Senior management108 (10.7)95 (11.0)13 (8.6)
     Middle management158 (15.6)141 (16.4)17 (11.2)
     Employees173 (17.1)157 (18.3)16 (10.5)
     Labourers134 (13.2)114 (13.3)20 (13.2)
     Retired or not in work399 (39.4)317 (36.9)82 (53.9)
    Education0.877
    Living area§0.187
    Tobacco consumption0.006
     Active199 (19.7)170 (19.8)29 (19.1)
     Past293 (29.0)225 (26.2)68 (44.7)
     Never520 (51.4)465 (54.1)55 (36.2)
    Treated for chronic respiratory disease or congestive heart failure
     Asthma58 (5.7)58 (38.2)
     COPD24 (2.4)24 (15.8)
     Heart failure36 (3.6)36 (23.7)
     Other57 (5.6)57 (37.5)
    Close family member treated for chronic respiratory disease or congestive heart failure0.330
     Overall135 (13.3)120 (14.0)15 (9.9)
     Asthma62 (45.9)54 (45.0)8 (53.3)
     COPD15 (11.1)14 (11.7)1 (6.7)
     Heart failure35 (25.9)30 (25.0)5 (33.3)
     Other40 (29.6)4 (26.7)36 (30.0)
    Breathing-oriented activityƒ0.002
     Often or from time to time316 (31.2)247 (28.7)69 (45.4)
     Rarely or never696 (68.8)613 (71.3)83 (54.6)

    Data are presented as n, n (%) or median (interquartile range), unless otherwise stated. Bold type represents statistical significance. #: answered “no” to “treated for chronic respiratory disease or congestive heart failure”; ¶: answered “yes” to “treated for chronic respiratory disease or congestive heart failure”: asthma n=38 (5.7% of the overall population), COPD n=25 (3.75% of the overall population), heart failure n=16 (2.4% of the overall population), n=1 mentioned cystic fibrosis (0.15%); +: corrected for multiple comparisons (n=69); §: three categories: urban, Paris area; urban, outside Paris area; rural; ƒ: details are given in supplementary table S1.

    • TABLE 2

      Dyspnoea ratings according to circumstances and respondent categories (for a better apprehension of the differences, the corresponding distributions are provided in supplementary figure S1)

      Whole populationRespiratory healthy group#Respiratory disease group¶p-value+Respiratory healthy groupRH-family− §RH-family+ ƒp-value+
      Subjects1012860 (85)152 (15)846¶¶726 (86)120 (14)
      Dyspnoea rating at rest7.00 (2.00–10.00)7.00 (2.00–10.00)8.00 (2.00–10.00)0.0357.00 (2.00–10.00)7.00 (2.00–10.00)7.50 (3.00–10.00)0.285
      Dyspnoea rating during moderate exertion7.00 (1.00–10.00)7.00 (1.00–10.00)8.00 (2.00–10.00)0.0207.00 (1.00–10.00)7.00 (1.00–10.00)7.50 (3.00–10.00)0.111
      Dyspnoea rating during sport##8.00 (1.00–10.00)8.00 (1.00–10.00)8.00 (5.00–10.00)0.4818.00 (1.00–10.00)8.00 (1.00–10.00)9.00 (3.00–10.00)0.054

      Data are presented as n, n (%) or median (range), unless otherwise stated. Bold type represents statistical significance. #: answered “no” to “treated for chronic respiratory disease or congestive heart failure”; ¶: answered “yes” to “treated for chronic respiratory disease or congestive heart failure”; +: corrected for multiple comparisons (n=69); §: answered “no” to “close family members treated for chronic respiratory disease or congestive heart failure”; ƒ: answered “yes” to “close family members treated for chronic respiratory disease or congestive heart failure”; ##: n=553 declared never wearing a face mask during this type of activity; ¶¶: n=14 declared never wearing a mask.

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        Supplementary material ERJ-01459-2021.SUPPLEMENT

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        Shareable PDF ERJ-01459-2021.Shareable

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      Lifting dyspnoea invisibility: COVID-19 face masks, the experience of breathing discomfort, and improved lung health perception – a French nationwide survey
      Laure Serresse, Noémie Simon-Tillaux, Maxens Decavèle, Frederick Gay, Nathalie Nion, Sophie Lavault, Antoine Guerder, Antoine Châtelet, Frédéric Dabi, Alexandre Demoule, Capucine Morélot-Panzini, Caroline Moricot, Thomas Similowski
      European Respiratory Journal Mar 2022, 59 (3) 2101459; DOI: 10.1183/13993003.01459-2021

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      Lifting dyspnoea invisibility: COVID-19 face masks, the experience of breathing discomfort, and improved lung health perception – a French nationwide survey
      Laure Serresse, Noémie Simon-Tillaux, Maxens Decavèle, Frederick Gay, Nathalie Nion, Sophie Lavault, Antoine Guerder, Antoine Châtelet, Frédéric Dabi, Alexandre Demoule, Capucine Morélot-Panzini, Caroline Moricot, Thomas Similowski
      European Respiratory Journal Mar 2022, 59 (3) 2101459; DOI: 10.1183/13993003.01459-2021
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