Effect of fan-to-face therapy on exertional breathlessness in adults with chronic lung disease

Background Exertional breathlessness is a common and disabling symptom for people with COPD and interstitial lung disease (ILD). Fan-to-face (F2F) therapy, which may stimulate trigeminal nerve afferents via cool facial airflow, is a promising intervention for breathlessness; however, its efficacy during standardised exercise is not well established. The objective was to investigate the acute effect of F2F therapy versus fan-to-leg (F2L) and no fan (NF) control conditions on breathlessness during a 4-min constant-work rate treadmill exercise test (4-min CWR-TT) among people with COPD or ILD. Methods In a randomised crossover trial, 32 participants (COPD: n=27; ILD: n=5) completed three 4-min CWR-TTs with F2F, F2L or NF. Breathlessness intensity (primary outcome) and physiological variables were recorded throughout. Results F2F reduced breathlessness intensity by 0.5 units on the Borg 0–10 scale, compared with NF, but did not reduce breathlessness intensity compared with F2L. F2F resulted in a lower facial skin temperature, but no differences were observed in ventilation, breathing pattern, heart rate or blood oxygen saturation. In an exploratory subgroup analysis of 20 participants with breathlessness intensity of ≥3 Borg units under NF, F2F decreased breathlessness intensity by 0.9 units during the 4-min CWR-TT, compared with NF, but not compared with F2L. Clinically meaningful reductions in exertional breathlessness intensity (≥1 Borg unit) were reported by 31% of the full sample and 45% of the exploratory subgroup under F2F versus NF, with similar proportions (31% and 40%) observed under F2L versus NF. Conclusion Whether due to stimulation of trigeminal nerve afferents or placebo effects, F2F therapy should reasonably be considered as a potentially effective nonpharmacological intervention for exertional breathlessness, especially among adults with chronic lung disease who report more severe breathlessness on exertion.