The role of airflow for the relief of chronic refractory breathlessness.

Abstract

Chronic refractory breathlessness is a major cause of suffering to people with advanced stage cardiorespiratory and some neurodegenerative diseases. It is a frightening, distressing and disabling symptom that imposes significant burdens on family members. Evidence is mounting for the role of facial or nasal airflow for the relief of chronic refractory breathlessness in those patients with mild hypoxaemia or normoxaemia. Airflow can be delivered from a cylinder of compressed medical air via face mask or nasal cannulae or a hand-held fan. The hand-held fan offers patients a simple, low-cost, self-management strategy that is not associated with any known risks. Therefore, it is timely and relevant to review the research available for the efficacy and appropriateness of facial or nasal airflow. There is sufficient review evidence available to suggest that airflow from the hand-held fan or medical air can provide clinically relevant and discernible relief of chronic refractory breathlessness at rest in patients with advanced diseases. The hand-held fan should be considered as one of the first interventions to try in management plans for patients who present with mild hypoxaemia or normoxaemia and chronic refractory breathlessness at rest or on minimal exertion. Emerging evidence indicates that airflow from the hand-held fan may also have an important role with exertion-induced breathlessness, decreasing distress and speeding recovery time after exercise, thereby helping patients self-manage their symptoms during everyday general activity and plan for crises of breathlessness, secure in the knowledge that they have a tangible, easily portable device to try in any circumstances.