Effectiveness of a hand-held fan for breathlessness: a randomised phase II trial

Abstract

BackgroundBreathlessness is common and distressing in advanced disease. This phase II study aimed to determine the use and acceptance of a hand-held fan (HHF) to relieve breathlessness, to test the effectiveness of the HHF and to evaluate the recruitment into the study.MethodsRCT embedded within a longitudinal study testing a HHF over time compared to a wristband. Patients were included in the longitudinal study when suffering from breathlessness due to advanced cancer or COPD III/IV and could opt in the RCT. Primary outcome was use of the HHF and the wristband after two months. Secondary outcomes were recruitment into the trial and change of breathlessness severity after two months, measured on the modified Borg scale. Baseline data were collected in a personal interview and follow-up data by monthly postal questionnaires.Results109 patients were recruited in the longitudinal study of which 70 patients (64%) participated in the RCT. Non-participants had statistically significant less breathlessness (Borg mean 2.6 (SD 1.48) versus 3.7 (SD 1.83); p = 0.003) and a better functional status (Karnofsky status mean 61.9 (SD 11.2) versus 66.7 (SD 11.0); p = 0.03). Attrition due to drop out or death was high in both groups. After two months, about half of the patients used the HHF but only 20% the wristband without a statistical difference (Fisher's exact test p = 0.2). 9/16 patients judged the HHF as helpful after two months and 4/5 patients the wristband. There was no difference in mean breathlessness change scores between the HHF (Borg change score: mean 0.6 (SD 2.10)) and the wristband (mean 0.8 (SD 2.67)) after two months (p = 0.90).ConclusionsSymptom burden and low functional status did not restrain patients from participation in the study. Finding a control for a visible intervention is challenging and needs careful consideration to what is acceptable to patients. The preliminary evidence of effectiveness of the HHF could not be proved. Patients often stopped using the HHF 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 HHF.Trial registrationClinicalTrials.gov Identifier: NCT01123902

Contributions of a hand-held fan to self-management of chronic breathlessness

“…Participants described fan-related benefits in terms of a quicker recovery from breathlessness rather than as a reduction in breathlessness severity, which has been the focus of recent trials [15][16][17][18]. With notable exceptions, patients used the fan when resting after physical activity rather than prior to or during activity.…”

“…Two randomised controlled trials (RCTs) found a statistically significant reduction in breathlessness severity from the fan, both of which focused on short-term administration (single use or during 1 week) [15,16]. Two further phase II mixed-methods RCTs were not designed to test efficacy but yielded qualitative data suggesting that the fan reduced recovery time after activity and conferred a feeling of control for some patients [17,18]. Two other qualitative analyses suggest that patient characteristics and nuances in the way fans are used may determine the degree and type of benefit experienced [19,20].…”

Palliative care in the ICU: relief of pain, dyspnea, and thirst—A report from the IPAL-ICU Advisory Board

“…Patients who were near death and at risk for dyspnea remained comfortable without oxygen [69]. A fan directed at the patient’s face may provide relief [70], although use in the ICU may be limited by bioengineering restrictions.…”

Luftnot, Jucken und Depression in der Palliativmedizin

“…[7], psychomotorische Hemmung oder Aktiviertheit [8], Schlafstörungen [9] und Appetitverlust [10]. Aus der Anzahl der Symptome ergibt sich dann die Einstufung als leicht (4-5 Symptome), mittelgradig (6-7 Symptome) oder schwer (> 7 Symptome), wobei mindestens 2 Hauptsymptome gegeben sein müssen.…”