Tolerability and effectiveness of face-masks in reducing cough aerosols for children with cystic fibrosis.

Background: People with cystic fibrosis (CF) are recommended to wear face-masks when in healthcare settings. We previously demonstrated that face-masks significantly reduce the release of Pseudomonas aeruginosa (P. aeruginosa) aerosols during coughing in adults with CF. There is a knowledge gap in relation to the impact of mask wear in children with CF. This study aimed to examine the tolerability and effectiveness in lowering emissions of hospital-grade surgical and one type of commercially available cotton face-mask in children with CF.
Methods: Twenty children with CF and P. aeruginosa infection were recruited. Participants performed three cough manoeuvres in a validated cough aerosol system both with and without face-masks of differing wear time. Cough aerosols were sampled at two meters using an Andersen Cascade Impactor. Quantitative sputum and aerosol bacterial cultures were performed. Participants also rated the comfort levels of the face-masks.
Results: P. aeruginosa was cultured from the sputum in eight participants (40 %). During uncovered coughing (reference manoeuvre), seven of the 20 participants produced aerosols containing bacterial pathogens. There was a reduction in aerosolised bacterial load during coughing with both surgical and cotton face-masks. The mean percent reduction in CFU with both types of face-masks was 82 % (95 % CI 56 - 108) during the immediate face-mask wear test compared to the uncovered cough test. Face-masks were generally well tolerated.
Conclusions: Face-masks are well tolerated and effective in reducing cough-generated bacterial aerosols in children with CF.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The following authors, George Tay, Michelle Wood, Congrong He, Kim Smith, Emma Ballard, and Lidia Morawska; declare no specific conflicts of interest related to the current manuscript. Rebecca Stockwell has received funding from a CF Foundation grant and a Vertex Travel grant. Claire Wainwright has received honoraria paid to her institution for presentations, educational meetings, and data safety monitoring roles, as well as serving as Deputy Editor for Thorax, Associate Editor for Respirology, and on the International Advisory Board for Vertex Pharmaceuticals. Scott Bell has received grants from the Cystic Fibrosis Foundation (BELL14A0 and BELL19A0), the National Health and Medical Research Council (NHMRC) of Australia (APP1102494), and payments to his institution from Vertex Pharmaceuticals (2020–2022), and the Cystic Fibrosis Foundation (USA) in March 2023 for presentation, educational meetings and advisory boards as well as holding unpaid leadership, committee, and data safety monitoring roles.
(Copyright © 2025 European Cystic Fibrosis Society. All rights reserved.)