Blowing Cool Air on Face Can Ease Breathlessness While Walking

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by Steve Bryson PhD |

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hand-held fan | COPD News Today | illustration of a woman walking

A hand-held fan blowing air on the face eased breathlessness in people with chronic obstructive pulmonary disease (COPD) during short periods of low-intensity walking exercise, a small study reports.

“Our positive preliminary findings suggest that fan therapy merits further investigation in larger and more methodologically rigorous studies,” the researchers wrote.

The study, “Impact of fan therapy during exercise on breathlessness and recovery time in patients with COPD: a pilot randomised controlled crossover trial,” was published in the journal ERJ Open Research.

Exercise interventions for people with COPD have been shown to ease breathlessness and improve physical function, as well as reduce exacerbations and hospitalization.

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However, maintaining these benefits requires continuous exercise, which is, conversely, limited by breathlessness. As such, any intervention that can help COPD patients self-manage their exercise-induced breathlessness is needed.

Studies suggest that cool airflow across the face — from room air delivered under pressure or using a fan — can reduce breathlessness at rest. Fan therapy in patients with chronic breathlessness has helped control breathing at rest, but whether it can benefit COPD patients during exercise is unknown.

To find out, researchers based at the King’s College Hospital NHS Foundation Trust and the University of London designed a controlled crossover study (NCT03137524) to investigate the effect of fan therapy on exercise-induced breathlessness, its acceptability, and the reproducibility of any observed improvements.

“We hypothesised that fan therapy would reduce exercise-induced breathlessness and improve post-exercise recovery time in patients with COPD,” the team wrote.

The study included 14 patients who completed the trial protocol. Their median age was 66.5; 10 were women.

Seven participants were randomly assigned to fan therapy — a commercially available hand-held fan pointed at the face — during a six-minute walking test (6MWT). The remaining seven received no intervention. A 30-minute recovery period followed the test.

For crossover, participants who first received fan therapy repeated the test without any such intervention, while those who did not initially receive fan therapy were assessed with fans. They then completed an acceptability questionnaire.

To assess reproducibility, patients were again randomly assigned fan therapy or no fan therapy seven days later, and the walking tests were repeated.

The primary outcome was a change in breathlessness from rest to immediately after the 6MWT, measured using a validated, self-reported numerical rating scale (NRS). A score of zero reflected no breathlessness while 10 was the worst possible breathlessness.

A secondary outcome included breathlessness intensity, as measured by the patient-reported modified Borg breathlessness (mBorg) scale at rest and at the end of the exercise. Here, zero reflected no intense breathlessness, five was severe breathless intensity, and 10 was the maximum.

Before exercise, there were no differences in resting NRS breathlessness, mBorg, heart rate, or blood oxygen saturation.

Following the first round of exercise, scores for the primary NRS outcome showed that physical activity with fan therapy resulted in significantly lower exercise-induced breathlessness, compared with no fan.

For breathlessness intensity as determined by mBorg, fan therapy resulted in smaller increases in perceived breathing difficulty. The fan’s use also led to a greater distance walked during six minutes and a shorter post-exercise breathlessness recovery time.

No treatment effects were seen in heart rate, blood oxygen levels, or the number of steps taken during the 6MWT. The results of the reproducibility assessment one week later were similar.

Fan therapy was accepted by 92% of participants with a median acceptability score of 4 out of 5. Overall, half (53%) reported no additional burden of fan therapy during the walking test. Most liked the fan, found it a minimal burden, were confident to use it, and understood how it helped.

Patients perceived the fan to be effective during exercise and to help resolve breathlessness after the exercise test. In addition, patients who had never used fan therapy reported that they would use a hand-held fan during everyday life, which “reinforces the acceptability of this intervention,” the researchers wrote. One participant said that using the fan negatively impacted their walking style.

A male participant said the intervention was “very useful during exercising.” A woman reported, “I think it worked … it helped my breathing.” Another woman said, “It acts as a distraction from my breathing, which I find useful.”

Overall, “fan therapy using a low-cost, readily available handheld fan was acceptable and provided symptomatic relief to patients with COPD during a short period of low-level exercise (walking),” the team concluded.