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Smoke particles from burning incense were found to cause cancer of the upper respiratory track. A 12 years long “Singapore Chinese Health Study” of more than 61,000 ethnic Chinese adults living in Singapore discovered ‘Among non-smokers who used incense during the day or at all times, the increased cancer risk was three times that of smokers.’ said Prof Koh of National University of Singapore.

The best way to avoid such risk is not to burn any joss-stick. However, incense has a significant meaning in the minds of many Asian cultures such as Hindu, Buddhist or Taoist. Mr Chung Kwang Tong, secretary-general of the Taoist Federation Youth Group in Singapore, explained that for Taoists, the smoke from incense is a way of communicating with the deities. Even for those who don’t practice any of these religions, may have inhaled incense smoke involuntary. Children are particularly at risk, there is mounting evidence that exposure to air pollution has long-term effects on lung development in children.

If stop burning incense is not an option, then protecting the vulnerable children with a face mask should be the second best option, right? To filter out the harmful smoke effectively, a face mask must produce two conditions simultaneously. First it needs to seal the user’s nose and mouth snugly. Second the filter material must be able to filter out those fine smoke particles. The use of simple surgical mask doesn’t help, as air-leaks are all around the face and smoke can easily by-pass the mask to enter the lung. Upgrade to an N95 respirator can help, only if you have access to a fit-test setup to ensure the mask is making a proper fit. Otherwise, if air-gaps exist in an N95 mask, it makes very little difference from using a cheap surgical mask. Buying an N95 mask is easy, but getting it fit-tested is not. Much to disappointment, there is no N95 mask available for children.

Chu Wa, a product designer and a father of two, is familiar with such problem. In 2003 during the SARS, after a fruitless search of N95 mask for his children, he discovered that there was no effective respiration protection for children available in the market. Can’t satisfy with the situation, he came up with a radical design of a parent/ child friendly face mask. The new mask can be cut to fit children (and adults), and parents can now fit-check the mask without the need of expensive fit-test equipments. The name TOTOBOBO (totobobo.com) suggests the solutions in Chinese: TOTO (transparent) BOBO (protection for baby). Parents can see through the transparent mask to examine the seal on the children face. He sent the new mask to a hospital and compared the visual fit-check method with a high-end fit-test setup call Porta-Count. The result shows strong correlation between the visual-check method and the official fit-test. “User seal-check has never been able to reach such accuracy. It is possible to ensure protection by simply looking through the mask.” according to Chu Wa. “I’m confident of TOTOBOBO and I welcome other hospitals with proper fit-test setups to challenge the initial result.” he said.

It looks like this new Singapore innovation is going to provide the much needed alternative to surgical masks or disposable N95 mask, especially for children suffering from incense smoke or other air pollution.

5 years ago during the SARS, it was impossible to find an effective respirator (commonly known as N95 mask) to fit the small faces of children. We saw many children wearing surgical mask or adult-size N95 respirator. Neither of these solutions was satisfactory.

Surgical mask, as the name suggested, is designed to protect nurses or surgeons from contaminated blood during an operation. In Japan or some Asian countries it is also used to reduce the risk of spreading the flu virus from the wearer if he/she is sick.
Surgical mask is never intended to protect the wearer from air-borne flu virus. There are gaps from both sides that virus can bypass the mask easily.

Respirator (e.g. N95 mask), on the other hand, is designed to protect the wearer from air borne contaminants (e.g. flu virus). However, this is only possible if the respirator is sealing the user’s face such that air must go through the filter media before entering the breathing zone. If there are gaps between the mask and the face, the result is not different from wearing a surgical mask. So don’t jump to the conclusion that you are OK as long as you are covered with an N95 mask. To ensure the effectiveness of a certain respirator, the user needs to put it on and pass a fit-test. The fit test is conducted by trained facilitator and with proper equipments. All these is simply too complicated for most people except for large institutions such as big hospitals. A study by the Prince of Wales Hospital in Hong Kong shows that, without a fit-test validation, there are 25% chances that you are not protected even you feel that you are. The problem is that the user seal check recommended by most manufacturers is just too ambiguous and unreliable.

Two hurdles for a good children mask
Perhaps there are at least two major reasons behind the non-existence of an effective respirator for children: the first is relating to regulatory stand and the second is related to business consideration of manufacturers.

1) Regulatory hurdle –N95 or related certification is issued by a regulatory agency called NIOSH, it stands for National Institute for Occupational Safety and Health. As the name suggested, its main task is to ensure the safety of workers in working environment through the proper definition and execution of standard and procedures. Here workers means nurses, doctors, firemen or army, but never children! In a way, N95 and children should be considered as mutually exclusive.
2) Business case (the lack of) – based on existing design, producing fitting respirators for children requires manufacturers a lot more sets of tools to cater for the wide range of face sizes. It is hard for a mask producer to justify such investment. Logistic is another issue, how are you going to distribute and keep stock of the right sizes at the right time? And finally, the quantity needed for children is definitely much lower than the doctors and nurses in hospitals.

All signs suggest this is likely to be a high cost, difficult and hardly profitable business, this is precisely why we are interested in it!

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Disclaimer: Asthma triggers are various and depends on patients. This article is not intended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care professional regarding any medical questions or conditions.
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Many asthmatic patients are given a prescription drug and inhalers to control their asthma condition. While these medications are helpful to control the symptoms of asthma, some patients prefer to limit the use of medicine to avoid potential side effects. Recent research also question the conventional wisdom of using “preventive” drugs to control asthma.

If you belongs to the non-drug camp, you may consider using a fitting face mask to block air-borne asthma trigger “just in time” to prevent it from flare out of control.

Asthma triggers can be broadly divided into 4 categories:
- air borne triggers (irritants, allergens, cold air)
- allergic triggers (non air borne, i.e. cockroaches)
- psychological triggers (stress, strong emotion)
- physiological triggers (exercise, excessive laughing, crying or even sneezing)

Airway contracted under asthma attack

A great portion of asthma attacks are triggered by air borne stimuli. Triggering stimuli such as irritants, allergens or simply cold air enters the air way (bronchial) causing a strong reaction, inflammation and/or narrowing of the airway tubes that leads to breathing problems. Most asthma attacks are mild, but even people with mild asthma can have a fatal attack. More than 5,000 deaths a year in the USA are attributed to the condition.

Perfect face seal is a pre-condition for cutting off air borne triggers

Symptom avoidance is a well know strategy for asthmatics. It is possible to cut off or reduce air borne triggers with a properly fitted filter mask (respirator). However choosing a suitable face mask can be a complicated issue.

There are two types of portable respirators in the market: reusable respirators and disposable respirators. High quality reusable respirator provides a better fit, but it is more bulky and less likely to be carry around, reducing the usefulness. Disposable respirators are more compact but can be easily distorted after use. This can affect the face-fit in subsequent use. Both types of respirators require a “fit-test” by professional to ensure a proper fit. However, it is not possible to conduct a “fit-test” each time when the mask is needed. Therefore the fit quality during use remains as a mystery.

Above dilemma is finally solved by TOTOBOBO mask, in a remarkably simple and intuitive way. First the transparent respirator allows you to see through the mask clearly and decide if the mask fits or not. Such visual check is easy to achieve each time when you need to put on the mask. Secondly, the mask can be trimmed to suit any unique face, including children’s. Finally the high quality reusable mask can be folded flat and fits into a shirt pocket, carry around and ready for the action whenever it is needed.

Currently TOTOBOBO mask is the only solution providing Easy fit-check, Customized fit and “Pocketability”. These are important factors if cutting off air borne triggers is in your plan against asthma attack.

Do consult your physician to come up with an overall plan for your own situation. You may consider TOTOBOBO mask as part of your overall strategy to reduce, but not to replace the use of medicine. A small percentage of patients’ asthma triggered by high moisture air might become worse after putting on a mask.

Below are some of the asthma triggers:

Air borne triggers

Irritants:
• Cigarette smoke
• Air pollution
• Cold air or changes in weather
• Strong odors from painting or cooking
• Scented products
Allergens:
• Animal dander (from the skin, hair, or feathers of animals)
• Dust mites (contained in house dust)
• Cockroaches dropping
• Pollen from trees and grass
• Mold (indoor and outdoor)
Cold air

Allergic triggers (non air borne)

• Cockroaches
• Mold (indoor and outdoor)
• Artificial sweetens
• Animals

Psychological triggers

• Stress
• Threaten
• Anger
• Shock

Physiological triggers

• Exercise
• Laughing
• Crying
• Sneezing

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More information:

Detail list of asthma triggers

Asthma may not require daily medication

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Testimonial from Teresa Lam, Hong Kong (edited March 28, 2008)
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“After trying the mask for a few weeks, I can say the TOTOBOBO mask does feel very comfortable. I’m quite positive that the mask had helped to reduce my asthma. The masks I used to use were not very air tight so most air I inhale would have gone through the side of the mask instead of any filtering.”

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Mask-face-fit testing is the job for an expert, and it require special equipments. There is QUALITATIVE fit test procedure based on subjective senses of the user. Then there is QUANTITATIVE fit test procedures based on objective measurement, comparing the particle counts inside and outside of the mask. Unfortunately, for a typical user, non of these fit test procedure is simple to do. In the US, NIOSH recommended such fit test to be conducted for each user once a year, or when the user’s body weight changed by more than 10%. Fit test can tell if the mask fit the user during the test, but unless the user do this test each time putting on a mask, he or she can can not be sure if the mask really is fitting during use. So far, fit testing procedure are limited to occupational workers. For general public, they don’t have the equipment nor the knowledge to conduct fit test.

In a recent study titled “Respiratory Donning in Post-Hurricane New Orleans” published on the CDC website in May 2007, researchers found only 24% participants demonstrated proper donning. This suggested the protection for at least 76% mask-wearing public would be compromised. Due to the experience of the Post Hurricane clean up, this is a group of user with higher level of knowledge about mask wearing. It is not difficult to imagine, this will be a big challenge for any emergency response when the public need to wear a fitting mask to ensure each other’s safety. CDC has been reluctant to recommend N95 mask for the public use, because for 1 in 4, the N95 mask may provides a fault sense of security while the it is not doing it’s job due to poor fit.

As the designer of TOTOBOBO mask, I try to solve this problem of fit-uncertainty in a different way. Previous fit-test procedure is needed because the user can not tell if a mask is properly sealing his face. Even when a mask looks like it is covering the nose and the mouth, there may be gaps underneath the mask which is difficult to see. The uncertainty is due to the fact that the mask is not transparent. Now what if the mask IS transparent? Then the user will be able to see if it fits right away, fitting or not, very clear and no more uncertainty. This simple method combines with a soft transparent material made mask-face fitting a lot more intuitive and with greater certainty.

With TOTOBOBO solution, it is now possible to perform a face-fit check every time before entering a potentially contaminated area. I think this is more reassuring than relying on a once-a-year fit test.