The Effectiveness of Heat and Moisture Exchanger Masks in Controlling Exercise-Induced Bronchoconstriction During Exercise in Asthma Patients: A Systematic Review and Meta-Analysis

Abstract

Objective: This systematic review and meta-analysis aim to evaluate the effectiveness of heat and moisture exchanger (HME) masks in controlling exercise-induced bronchoconstriction (EIB) during exercise in asthma patients. EIB, characterized by airway narrowing triggered by physical activity, affects a significant proportion of individuals with asthma, impeding their ability to engage in physical activities that can otherwise benefit their condition.

Methods: A comprehensive search of databases including AMED, PEDro, CINAHL, CENTRAL, MEDLINE, and Embase was conducted to identify relevant randomized controlled trials (RCTs). The studies were screened, and data were extracted and analyzed using the JBI tool. Five studies met the inclusion criteria and were subjected to critical appraisal using the Cochrane Risk of Bias 2 tool. Data were synthesized, and a meta-analysis was performed to determine the effect of HME masks on post-exercise FEV1 decline.

Results: The meta-analysis revealed that HME masks significantly reduced the decline in FEV1 post-exercise compared to placebo, with a standardized mean difference (SMD) of -0.775 (95% CI: -1.339 to -0.211, p = 0.007). Sensitivity analyses confirmed the robustness of the results, showing an SMD of -0.626 (95% CI: -1.105 to -0.147, p = 0.01) after excluding a high-bias study. Analyses focusing on sub-zero temperatures further supported the masks' efficacy, indicating a significant benefit with a mean difference of -15.014 (95% CI: -22.887 to -7.140, p < 0.001).

Conclusions: The findings suggest that HME masks can effectively mitigate EIB in asthma patients during exercise, particularly in cold environments. However, due to the limited number of studies and moderate-quality evidence, definitive recommendations cannot be made. Further research is required to explore the long-term effectiveness and potential adverse outcomes associated with HME mask use.