External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

Abstract

Background and study aims N95-filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (gastrointestinal lab) staff using N95FFR.

Patients and methods N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of gastrointestinal procedures with N95FFR and 1 day of gastrointestinal procedures with END plus N95FFR in random sequence; and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession.

Results Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31–61) performed 1 day of gastrointestinal procedures with an N95FFR and 1 day of gastrointestinal procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration, occurred while using an END plus N95FFR. Respiratory plethysmography peak-to-trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage.

Conclusions N95FFR related respiratory changes and symptom development may be mitigated by END use.

Publication History

Received: 29 July 2021

Accepted after revision: 25 May 2022

Accepted Manuscript online:
11 July 2022

Article published online:
14 September 2022

• References

• 1 Chu DK, Akl EA, Duda S. et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395: 1973-1987
• 2 Lee HP, Wang DY. Objective assessment of increase in breathing resistance of N95 respirators on human subjects. Ann Occup Hyg 2011; 55: 917-921
• 3 Fikenzer S, Uhe T, Lavall D. et al. Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clin Res Cardiol 2020; 109: 1522-1530
• 4 Khalid A, Romutis S, Ibinson J. et al. Acute physiological effects of N95 respirator use on gastroenterologists performing simulated colonoscopy. Gastrointest Endosc 2021; 94: 160-168
• 5 Bharatendu C, Ong JJ, Goh Y. et al. Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. J Neurol Sci 2020; 417: 117078
• 6 Dinardi RR, de Andrade CR, da Cunha Ibiapina C. External nasal dilators: definition, background, and current uses. Int J Gen Med 2014; 7: 491-504
• 7 Roithmann R, Chapnik J, Cole P. et al. Role of the external nasal dilator in the management of nasal obstruction. Laryngoscope 1998; 108: 712-715
• 8 Turnbull GL, Rundell OH, Rayburn WF. et al. Managing pregnancy-related nocturnal nasal congestion. The external nasal dilator. J Reprod Med 1996; 41: 889-902
• 9 Sadan O, Shushan S, Eldar I. et al. The effects of an external nasal dilator on labor. Am J Rhinology 2005; 19: 221-224
• 10 Griffin JW, Hunter G, Ferguson D. et al. Physiologic effects of an external nasal dilator. Laryngoscope 1997; 107: 1235-1238
• 11 Sultan S, Lim JK, Altayar O. et al. AGA rapid recommendations for gastrointestinal procedures during the COVID-19 pandemic. Gastroenterology 2020; 159: 739-58
• 12 Chu M, Nguyen T, Pandey V. et al. Respiration rate and volume measurements using wearable strain sensors. NPJ Dig Med 2019; 13: 1-9