Impact of Gas Masks on Work of Breathing, Breathing Patterns, and Gas Exchange in Healthy Subjects

Respir Care. 2018 Nov;63(11):1350-1359. doi: 10.4187/respcare.06027. Epub 2018 Jul 31.


Background: The gas mask is used to protect military and non-military personnel exposed to respiratory hazards (chemical, biologic, radiologic, and nuclear agents). The objective was to evaluate the impact of the gas mask on indexes of respiratory effort and breathing patterns in a human model because no data exist.

Methods: The design of the study was a crossover evaluation with four 10-min conditions in a randomized order: with and without wearing the gas mask when at rest and when exerting a standardized effort. During the studied conditions, 14 healthy subjects were evaluated for breathing patterns, indexes of respiratory effort (work of breathing, pressure-time product for esophageal pressure, and esophageal pressure swing) and capillary blood gases. Continuous SpO2 was recorded during the tested conditions.

Results: The indexes of respiratory effort significantly increased when subjects wore the gas mask under the tested conditions (at rest and during effort). The work of breathing was significantly augmented with the mask (at rest, 0.40 ± 0.32 J/cycle vs 0.25 ± 0.10 J/cycle; effort, 5.96 ± 3.32 J/cycle vs 4.43 ± 2.50 J/cycle; P < .001). The other indexes of effort (esophageal pressure-time product and esophageal swing were all significantly increased, from 30 to 60%, with a gas mask in comparison with at baseline without a gas mask). The impact on breathing patterns and PaCO2 was limited, without significant differences. Moderate hypoxemia was present during effort and was not increased by the gas mask.

Conclusions: This study demonstrated a substantial increase in the indicies of respiratory effort both at rest and during exercise with a gas mask. Our measurements and findings may be referred in future research and development studies in this field. ( registration NCT02782936.).

Keywords: biological; breathing pattern; chemical; gas exchange; gas mask; nuclear and explosive; radiological; respiratory effort index; respiratory protective devices; work of breathing.

MeSH terms

  • Adult
  • Blood Gas Analysis
  • Cross-Over Studies
  • Esophagus
  • Female
  • Healthy Volunteers
  • Hemoglobins / metabolism
  • Humans
  • Hypoxia / etiology
  • Male
  • Middle Aged
  • Oxygen / blood
  • Physical Exertion / physiology
  • Pressure
  • Pulmonary Gas Exchange*
  • Random Allocation
  • Respiratory Protective Devices* / adverse effects
  • Rest / physiology
  • Work of Breathing*


  • Hemoglobins
  • Oxygen

Associated data