Bausewein, C., Booth, S., Gysels, M., Kuhnbach, R., & Higginson, I.J. (2010). Effectiveness of a hand-held fan for breathlessness: A randomised phase II trial. BMC Palliative Care, 9, 22.

The objective of the study was to determine effectiveness and acceptance of use of a handheld fan to relieve breathlessness in patients with advance chronic obstructive pulmonary disease (COPD) and cancer.

Patients were randomly assigned to the fan or control groups. Control patients were given a wristband and instructed to wear it constantly and pull it at short intervals when breathless. Patients in the intervention group were given a handheld fan, shown how to use it (aimed at the central part of the face), and given a booklet with instructions for use. Data were collected at baseline and by monthly postal questionnaires for six months or until the patient died.

• The study reported on a sample of 36 evaluable patients.
• The mean age was 65.6 years (SD = 8.8 years).
• Of the sample, 51% were males and 49% were females.    
• Thirty percent of patients randomized had advanced cancer.
• The number of those completing the trial is not described.
• Types of cancer are not described.

The study was conducted in an unspecified single site in the United Kingdom.

• Patients were undergoing end-of-life care.
• The study has clincal applicability for end-of-life and palliative care.

The study was a randomized controlled trial.

A modified Borg scale was used.

• Twenty-nine percent in the intervention group and 41% in the control group initially randomized died before completion of the study, and missing data across groups were an average of 55%. 
• After two months, no significant differences in outcomes were seen between groups.
• Of 23 patients in the intervention group at two months, 9 considered it helpful and 14 did not. 
• Power analysis showed that sample size at two months was sufficient to detect an effect size of 2.5, but the actual effect size seen was .08, showing no meaningful effect.

This study shows that use of a handheld fan for breathlessness was not effective.

• The study had a small sample size of less than 100.
• The control condition used may not have been useful . 
• This study demonstrates the difficulty in providing an appropriate control condition with nonpharmaceutical types of interventions and the difficulty in attempting to evaluate longer term results in patients with advanced disease.  
   

Findings do not show any benefit of a handheld fan to help patients with the sensation of breathlessness.