Does altering the air holes have a positive effect on the hand warmers?

Does altering the air holes have a positive effect on the hand warmers?

I've heard people say that the hand warmers become hotter when they are removed from their cloth bags although I think they can stop heating if left out of their cloth bags too long, perhaps because of wind or too much heat loss stops the evaporation of the fuel or. ....
If better air flow does increase the heat output then why can't increasing the holes do the same thing?
I see that the hotter s-boston warmers cloth bags have cut outs that let air get to the metal holes directly, I wonder why this is when other warmers don't have such holes in their cloth bags...

Has anyone tried increasing the number of or size of the holes in the metal covers to see if this might have a positive effect on the heat output of the hand warmer or perhaps reduce the heaters suffocating in one's pocket or?

Does altitude have any effect on hand warmers? I live in CO at about 6,000 feet and the air is thinner. Are there any adjustments appropriate for this?

I'm surprised the makers don't have a way of the consumer adjusting the desired heat output as needed and if they did such a design, I suppose it might be where the air holes can be adjusted or covered with a sliding mechanism.

Thanks for the discussion!