Do handheld fans relieve breathlessness in patients – and what is the evidence?

The following article was written and provided by The National Asbestos Helpline. More information is available at www.nationalasbestos.co.uk.

There is plenty of anecdotal evidence from respiratory professionals and patients that a handheld fan can relieve breathlessness, but it is a physiological method that is not fully understood.

A number of research studies encourage the use of fans to control breathlessness. The study, ‘Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial’ (2010), recommends the technique ‘as part of a palliative management strategy for reducing breathlessness associated with advanced disease’.

Fans are a potentially useful and cheap non-pharmalogical intervention. The technique seems to have no side effect and gives patients some control over their symptoms. Cancer Research UK, Macmillan and the British Lung Foundation all recommend the use of fans to help reduce breathlessness.

But some hospitals are wary of promoting fans as a breathlessness intervention, even banning their use, because of the lack of research evidence.  The study, ‘Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases’ (2008), states that it could not judge the evidence for the use of fans as there is insufficient research data.

The 2010 study ‘Effectiveness of a hand-held fan for breathlessness: a randomised phase II trial’ is more sceptical and concludes that ‘the preliminary evidence of effectiveness of the handheld fan could not be proved. Patients often stopped using the handheld fan but a small group seemed to benefit which was not necessarily related to a relief in breathlessness. Therefore, more work is necessary on selecting and identifying those who might benefit from the handheld fan’.

It is also not known how the fans manage to reduce breathlessness although studies theorise that it could be the cooling effect on the nose and mouth area, rather than any increase in the airflow. ‘The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnoea: a qualitative Phase I study’ (2006), suggests that the air triggers the mamalian diving response (or diving reflex) when the sensitive trigeminal nerve in the nasal cavity and face is cooled. This prompts the body to conserve oxygen by reducing the heart rate and breathing through the autonomic nervous system, which controls vital body systems, such as circulation and respiration. The same relief can be replicated by a cool flannel compressed against the face.

Even without conclusive research evidence and whether or not the technique simply has a placebo effect, respiratory professionals are recommending the use of handheld fans where they benefit a patient and the management of their symptoms.

Ruth Thomas, Specialist Respiratory Nurse base in Milton Keynes, says: “I frequently use hand held fans during pulmonary rehabilitation sessions, giving to patients who are very breathless after a cardiac exercise, as aids recovery time even quicker than use of inhalers. Patients who benefit are advised to use as needed whenever more breathless than usual to help regain breathing control.”

However, the situation remains that until there is evidence that proves handheld fans are medically useful, their use will remain inconsistent and without suitable protocol. That is a shame when the technique appears to be a safe and simple way to help patients. The fans are inexpensive, portable, enhance self-efficacy and give the patient some sense of control over their breathing.

How to use the handheld fan to relieve breathlessness?

It is important to check with a GP, respiratory consultant, respiratory nurse, respiratory physiotherapist or other qualified medical professional before a patient uses the fan technique.

When a patient feels breathless after any physical activity, anxiety or stress they should:

• Find a comfortable place to stop and rest. This could be in a chair and leaning forward on the elbows; sitting and resting forward on a table top; or standing and leaning forward on a kitchen worktop, back of a chair or even a shopping trolley.

• Turn the handheld fan on and position it six inches or 15 cm (about the distance from the outstretched tip of the forefinger to the top of the thumb) from the face.

• Ensure that the air from the fan blows towards the central part of the face. The cool draught should be felt around the sides of the nose and across the patient’s top lip.

• The position should be held and the fan used until the patient regains control of their breathing. This could be a few minutes through to 10 minutes. The time varies depending on the patient.

It may benefit the patient to use the fan while employing other methods of breathlessness management such as breathing techniques, relaxation and mindfulness. The fan technique can also be used at the same time as nasal oxygen.

Research references

Richard M. Schwartzstein, Karen Lahive, Alan Pope, Steven E. Weinberger, and J. Woodrow Weiss. Cold Facial Stimulation Reduces Breathlessness Induced in Normal Subjects. American Review of Respiratory Disease 1986; 10.1164/ajrccm/136.1.58

Booth S, Farquhar M, Gysels M, Bausewein C, Higginson IJ (2006) The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnoea: a qualitative Phase I study. Journal of Palliative and Supportive Care 4: 287-293.

Bausewein C1, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005623. doi: 10.1002/14651858.CD005623.pub2.

Bausewein C, Booth S, Gysels M, Kühnbach R, Higginson I. Effectiveness of a hand-held fan for breathlessness: a randomised phase II trial. BMC Palliative Care20109:22 DOI: 10.1186/1472-684X-9-22

Galbraith S, Fagan P, Perkins P, Lynch A, Booth S. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. Journal of Pain & Symptom Management 2010; 39 (5):831-838.

Amy P. Abernethy, Christine F. McDonald, Peter A. Frith, Katherine Clark, James E. Herndon, Jennifer Marcello, Iven H. Young, Janet Bull, Andrew Wilcock, Sara Booth, Jane L. Wheeler, James A. Tulsky, Alan J. Crockett, and David C. Currow. Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial. Lancet. 2010 Sep 4; 376(9743): 784–793.

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