Mask-wearing is uncomfortable for just about everyone, but people with COPD and other breathing disorders have more reason than most to complain. Having a serious respiratory disease can legitimately make breathing through a face mask more difficult, even though face coverings are not actually dangerous for people with COPD (as most doctors agree).

Unfortunately, masks have become an unavoidable feature of daily life in many places, as they are a central part of the public health efforts to control the spread of COVID-19. This has left many people with COPD wondering how to cope with the discomfort of mask-wearing and, in some cases, even looking for exceptions or alternative solutions to wearing a mask.

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That's why we created this guide to address the logistics of masking for people with COPD. In it, you'll find a variety of practical strategies you can use to not only make wearing a mask more tolerable so you can enjoy outings and other activities without feeling breathless and fatigued.

Throughout this guide you'll find tips for coping with a variety of situations, including those that tend to be especially challenging for people with COPD (e.g. hot weather, prolonged masked outings, and using supplemental oxygen while wearing a mask). We'll also dissect the pros and cons of different kinds of masks, and how to choose one that is both effective and easy to breathe in with COPD.

Face Masks & COPD: What Every COPD Patient Should Know

We know that many people with respiratory diseases like COPD have questions and concerns about how wearing a mask affects their health and their breathing. Here are a few of the most common ones that you might have heard before or worried about yourself:

• Is it safe for people with chronic respiratory diseases like COPD to wear a mask?
• Can wearing a mask impair your breathing or reduce how much oxygen you get when you breathe?
• Can people with COPD and other serious respiratory disease get exempted from having to wear a mask?

So before we jump right into the “survival strategies” portion of this guide, we'd like to take a moment to address these and other common questions that people have about masking & COPD. If you'd like to skip ahead, you can click the following links to go straight to the sections on Choosing a Mask for COPD or Tips & Tricks for Making a Mask More Bearable.

Is it Safe to Wear a Mask if You Have COPD?

Despite the fact that wearing a mask can cause a great deal of discomfort, it's important to know that they're not actually dangerous for your health. In fact, some of the largest COPD & lung disease organizations in the US have gone out of their way to reassure patients that wearing a face covering is not only safe, but also important for people with COPD and other chronic lung diseases.

Organizations endorsing the safety of masking for COPD patients include:

• The COPD Foundation
• The American Lung Association
• The American Thoracic Society
• The American College of Chest Physician

It's important to note that the list above is far from comprehensive; a large number of healthcare networks and medical organizations across the country have endorsed masking as a means to reduce virus transmission.

Can Wearing a Mask Impair Breathing?

Since the advent of mask mandates, many people—especially people with respiratory diseases—have been concerned that wearing a face mask might impair their ability to breathe. Some have even claimed that wearing a mask can reduce blood oxygen levels or cause too much carbon dioxide to get absorbed into the blood.

The good news is that these concerns are unfounded; studies consistently show that face masks don't impair breathing—and that holds true for healthy adults, older adults, and people with chronic lung diseases (including COPD).

That's because both oxygen and carbon dioxide can pass through masks very easily; the molecules are many times smaller than the respiratory droplets that masks are meant to block. This means that breathing in a mask won't cause carbon dioxide to get trapped inside it, nor will it block oxygen from getting in.

This is confirmed by multiple studies that measured healthy participants' blood oxygen and carbon dioxide saturation while wearing a mask. These studies find that wearing a mask affects blood levels of carbon dioxide and oxygen minimally, if at all (even during exercise), and report a near-zero risk of any significant breathing impairment for the general population.

Studies on people with COPD, including those with severe lung impairment, show similar results. One study, for instance, found that COPD patients wearing masks experienced no significant decrease in oxygen levels (and no significant increase in carbon dioxide levels) both at rest and during physical activity.

One exception to this is N95 masks. Though they are very effective at preventing virus transmission, N95 masks create a lot more airflow resistance than a typical cloth or surgical mask.

Of course, this isn't a concern for the vast majority of people since N96 masks are meant for healthcare workers and are not recommended for general public use. As we discussed above, a regular cloth or surgical mask will not impair your breathing even if you have COPD or another serious respiratory disease.

If you'd like to learn more about research on mask safety and efficacy, check out this comprehensive analysis from the Scientific Advisory Group (PDF link).

Why is Wearing a Mask So Uncomfortable for People with COPD?

As we discussed in the section above, many studies have confirmed that masks do not actually impair your breathing. But that doesn't explain why wearing a mask can make you feel like it's harder to breathe.

To understand why that is, you have to know a few things about the mechanics of breathing; namely, that breathlessness is a sensation that can be triggered by a variety of different factors, some of which have nothing to do with how much oxygen you're getting or how well you can breathe.

One of these factors is airflow resistance, which affects how much effort it takes to pull air into your lungs when you breathe. Slight changes in airflow resistance (e.g. from breathing through a mask) can trigger feelings of anxiety and breathlessness even if nothing is actually impairing your ability to breathe.

This is a normal physiological reaction to airflow resistance that—in and of itself—isn't a cause for serious concern. It's essentially your body's way of alerting you in case you're actually suffocating; it just tends to be very sensitive, which can lead to false alarms.

So while it's important to pay close attention to your symptoms when you have COPD, it's also important to remember that shortness of breath is just a feeling and that it can have a totally benign cause. So even if the airflow resistance from wearing a mask might make you feel uncomfortable and breathless, you can confidently reassure yourself that it doesn't pose an actual risk to your health.

Can You Be Exempted from Mask Requirements if you Have COPD?

The short answer to this is a conditional yes; the CDC has acknowledged that people with disabilities that make it difficult to breathe in a mask (which could include some people who are disabled because of their COPD) may be exempted from wearing a mask. However, this isn't a blanket excuse for all COPD patients to forego mask-wearing; it just means that some COPD patients in some situations should get exemptions—not that all people with COPD should choose to not wear masks.

In fact, doctors strongly urge all COPD patients to wear a mask if they are able to, since people with COPD are more vulnerable than most to severe complications and death from COVID-19. As researchers wrote in an article published in the European Respiratory Journal, “Relieving respiratory patients from the obligation to wear masks could be highly deleterious for them, since by definition those patients with respiratory conditions who cannot tolerate face masks are at higher risk of severe COVID-19.”

Other medical professionals agree that everyone should wear a mask, regardless of medical condition, since masks have “no effect on respiratory mechanics.” As one doctor put it, “I believe that most people need education on proper use rather than exemption,” including fragile respiratory patients.

If you have COPD, you should be taking every reasonable precaution you can manage to avoid getting sick, including wearing a mask in situations where you're at risk of being exposed to other people's germs. This is especially important if not yet been fully vaccinated, or if you belong to a group for which the vaccine is known to be less effective (e.g. if you are an immunocompromised person or over the age of 65).

You should also keep an eye on your local and national health recommendations, which provide up-to-date guidance on masking and other COVID-prevention measures for both vaccinated and non-vaccinated individuals.

Unless your doctor advises against it or you absolutely cannot tolerate it because of your respiratory symptoms, the benefits of masking are likely to far outweigh any discomfort you might feel. However, that's not to say that the discomfort of wearing a mask is trivial; we don't want to downplay how absolutely miserable it can be.

That's why we're going to spend the rest of this post exploring a variety of different strategies you can use to minimize that discomfort and be able to wear a mask without feeling breathless or fatigued.

Choosing the Right Mask for COPD

The most important factor in mask-wearing comfort is the face covering itself. While this might seem like a no-brainer, finding a mask that fits right, works right, and doesn't create too much resistance when you breathe can be a difficult task.

Unfortunately, a lot of people wear uncomfortable masks that they don't like because they don't realize there are better options out there. But if you take some time to research (and even try out) different types of face coverings, you might be surprised at how much more comfortable the “right” mask can be.

Here are some of the main criteria you should consider when choosing a mask:

Mask Layers

Most face coverings are made up of multiple layers of fabric sewn together, a characteristic often referred to as the material's “ply.” A “three-ply” mask, for example, has three layers of fabric, while a “one-ply” mask has only one.

The number of layers your mask has will effect not only how well it filters out germs but also how comfortable it is to breathe in. The CDC recommends wearing a mask made of at least 2-ply fabric, which is a good middle ground between masks that are less effective (1-ply) and masks that create a lot of resistance when you breathe (e.g. 3-ply and up).

Mask Fit

How a mask fits on your face affects not only how comfortable it is to wear, but also how well it works at protecting you from germs. Unfortunately, many people wear masks incorrectly, increasing their risk of being exposed to other people's germs.

A well-fitting mask is one that fits snugly—but not too tightly—with all the edges sitting flat against your face. A mask that's too loose won't filter air correctly, while a mask that's too tight can be uncomfortable to wear for long periods of time.

Ideally, your mask should also have nose wire to help the mask fit around the curve of your nose without leaving gaps. The goal is to make sure you don't leave any space between the mask and your face that will allow unfiltered air to slip through.

You can help a loose-fitting surgical mask fit better by wearing a cloth mask over the top to hold it snug against your face. However, this method creates extra airflow resistance that might make it too uncomfortable for people with COPD and other respiratory diseases.

If you have a mask that fits too loose, you can always tie a knot in the ear loops to shorten them in a pinch. You can also get masks that that tie around the back of your head, which not only makes them conveniently size-adjustable but also reduces ear soreness (a common complaint about masks that cling to your ears).

Material & Mask Type

The material your mask is made of helps determine not only how effective it is, but also how comfortable it is to wear and breathe in. There are many different types of mask materials, but the types of masks recommended by the CDC for public use generally fall into one of two main types: cloth masks and surgical masks.

Reusable Cloth masks

Cloth masks are face coverings made from one or more pieces of woven fabric sewn together. The type of fabric varies, though most are made from cotton, polyester, and other fabrics commonly used in clothing.

Studies show that different types of cloth masks vary in how well they filter out germs (or, to be more precise, respiratory droplets that carry germs). However, this has less to do with what kind of fabric the mask is made of than how tightly woven that fabric is.

Fabric that's too light (e.g. mesh or see-through) doesn't make a very good filter, while fabric that is too dense can create too much resistance when you breathe. Unfortunately, finding a cloth mask that's both comfortable and effective is always balancing act: you want a mask that's dense enough to block as many droplets as possible while still being light enough to allow air to pass easily through.

Here are additional recommendations from the CDC regarding cloth mask materials:

• The mask should be made from a washable material (so it's easy to clean between uses)
• The mask should not be see-through (if you hold it up to a bright light source, the fabric should be woven tightly enough to block the light from shining through)
• The mask should not have holes, gaps, valves, or any other opening in the fabric that would allow air to go in or out without being filtered through the mask material first

Another important characteristic to consider when choosing a cloth mask is the “feel” of the mask material against your face. You want a mask made from a flexible, soft, high-thread-count fabric that doesn't cause any itching or irritation on your skin.

You might need to try out a few different types of masks before you find a design and material that works for you. You can also look for recommendations online by searching for “breathable” masks and reading reviews written by other people with respiratory diseases.

Disposable Surgical Masks

Surgical masks are made up of a special type non-woven fabric made from plastic (often polypropylene). This type of fabric makes a good face covering because it is acts as a decent filter while still letting air through relatively easily when you breathe.

Because of this, many people find surgical masks easier to breathe in compared to the relatively-heavy fabric required for cloth masks to be effective. Surgical masks also tend to be somewhat moisture-resistant, which helps them not get damp as quickly from the moisture in your breath.

There are several different types of surgical masks rated for different medical purposes as well as generic, non-medical “surgical masks” you can find at many stores. For the general purpose of protecting yourself when you're around other people and out in public, minimum protection surgical masks & most generic versions should work just fine.

You should, however, make sure that whatever surgical mask you choose is made from at least 2-ply fabric and has a nose wire at the top. Like all masks, your surgical mask should fit snug and comfortably on your face without leaving any gaps for unfiltered air to get through.

Cloth Masks vs Surgical Masks: Which One Should You Use?

Cloth masks and surgical masks are both approved by the CDC, so which type you choose to use is ultimately up to you. Both have their own benefits and drawbacks, and some might be better suited to certain people or situations.

One of the biggest benefits of cloth masks is that they are re-usable, which makes them very cost effective over time. However, washing cloth masks can be very inconvenient, especially when you need a fresh one every day.

Surgical masks, on the other hand, are single-use, which is very convenient; they're very low-maintenance and all you have to do is thrown them away after use. However, this also means that you have to keep buying new ones, which can get expensive and create a lot of extra waste.

It's also worth mentioning that some studies indicate that cloth masks don't work quite as well as surgical masks at filtering out the respiratory droplets that carry germs. However, even if they are somewhat less effective, experts agree that multi-layer cloth masks still offer a worthwhile amount of protection and remain an important tool in combating the spread of disease.

Many people use a combination of cloth and surgical masks, both separately and/or at the same time. For example, you might want to wear a cloth mask over a surgical mask for extra protection, or keep a box of surgical masks around just in case there's a time that you can't find a clean cloth mask to wear.

Tips & Tricks to Make Wearing a Mask More Bearable if You Have COPD

Now that we've covered the basics of how to choose a breathable mask, we'd like to share some additional tips that can make wearing that mask even more comfortable if you have COPD. In the following sections, you'll find more than a dozen practical strategies that can help take the edge off mask-wearing and help you avoid feeling anxious or breathless when you have to wear a mask.

Take Time to Rest

It's not fun to feel tired and short of breath when you go out to do something fun, which is why avoiding over-exertion is a common concern for many people with COPD. Unfortunately, for those who struggle with mask-wearing, it can be even harder to manage breathlessness and other COPD symptoms while wearing a mask.

Pay close attention to how you feel when you're out and about so you can catch the breathlessness early and take the time you need to rest. If you're out with other people, don't be afraid to excuse yourself for a few minutes or let them know when you need to slow down or take a break.

Take Mask Breaks

Many people with COPD and other respiratory diseases struggle wi