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

The objective of this study was to investigate whether a handheld fan reduces the sensation of breathlessness in patients with dyspnea.

Room temperature and humidity were controlled, and the fan was directed to either face or leg for five minutes. This was followed by a 10-minute washout followed by repeat intervention, as crossover dyspnea scores were collected at baseline, at completion of each 5-minute intervention, and after 10-minute washout of each intervention. Additional data collected included pulse rate and oxygen saturation after each 5-minute use of the fan and each 10-minute washout.

• The study reported on a sample of 49 participants.
• The mean age was 71.3 years, with a range of 33–90 years.
• Of the sample, 27 were females and 23 were males.
• Diagnoses included chronic obstructive pulmonary disease (26), lung cancer (primary or secondary) (11), asthma (8), heart disease (15), bronchiectasis (7), pneumonitis (4), other (20), and multiple diagnoses (26).
• Other key characteristics included patients in the United Kingdom with refractory breathlessness.
• Patients were permitted to be on opioids, corticosteroids, and sedatives.
• Exclusion criteria included use of continuous or short-burst oxygen during the study period and hemoglobin less than 10 gm/dl.

The study was conducted in an inpatient medical center and a hospice setting in the United Kingdom.

• Patients were undergoing end-of-life and palliative care.
• The study has clinical applicability for late effects and survivorship.

The study had a randomized, controlled, crossover design.

Visual analogue scale (VAS) 10 cm for dyspnea was used. Anchors were no shortness of breath to worst shortness of breath. VAS calculations were performed by a noninvestigator.

Only eight participants perceived benefits of the fan to the face at the conclusion of 5 minutes, but 19 participants perceived benefit at the end of the 10-minute washout. The eight who initially perceived benefit did register reduction in benefit during the washout period. A significant difference in VAS scores was seen between the two treatment arms with reduction in breathlessness when the fan was directed to the face (p = 0.003).

Use of a fan pointed at the face may reduce the sensation of breathlessness in a controlled temperature and humidity environment.

• Washout period of 10 minutes did not appear adequate because the benefit of the fan on the face for some resulted in sustained reduction of dyspnea at the end of 10 minutes. Because washout time may have been incomplete, the results of the second arm of the study may have been biased, and no actual control period in the study existed. 
• The study had a relatively small sample size of less than 100.
• Results were found with temperature and humidity control, not just fan use.

Handheld fans are inexpensive and easy and permit empowerment of patient initiation of symptom management. This study suggests that this intervention, in a controlled temperature and humidity condition, will decrease the sensation of dyspnea. Patients may continue to experience benefit from the intervention even after its discontinuation, so it may be extremely helpful as bridge management when awaiting onset of an intervention such as a pharmacologic agent.