From the Guidelines
Fans are used in patients' rooms during COPD exacerbation admissions primarily to help alleviate the sensation of breathlessness by stimulating the trigeminal nerve and reducing the perception of air hunger and dyspnea. When a fan directs cool air across the face, particularly over the nose, mouth, and cheeks, it creates airflow that tricks the brain into feeling that breathing is less labored, even when respiratory function remains compromised. This simple intervention has minimal side effects and can be used alongside standard COPD treatments like bronchodilators, corticosteroids, and oxygen therapy, as recommended by guidelines such as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1 and the European Respiratory Society/American Thoracic Society guideline 1. Patients typically benefit from a small portable fan positioned about 6 inches from the face, directed at the central facial area, which they can control themselves. The psychological comfort of having some control over breathlessness can also reduce anxiety, which often worsens dyspnea in a vicious cycle. Some key points to consider in the management of COPD exacerbations include the use of short-acting inhaled β2-agonists, with or without short-acting anticholinergics, as the initial bronchodilators to treat an acute exacerbation 1, and the initiation of maintenance therapy with long-acting bronchodilators as soon as possible before hospital discharge. Healthcare providers should ensure the fan is kept clean to prevent infection risk and should position it so it doesn't interfere with oxygen delivery devices if the patient is using them. Key considerations in the use of fans and other interventions for COPD exacerbation management include:
- Minimizing the negative impact of the current exacerbation and preventing subsequent events 1
- Improving lung function and oxygenation, and shortening recovery time and hospitalization duration with systemic corticosteroids 1
- Reducing the risk of early relapse, treatment failure, and hospitalization duration with appropriate therapy, including antibiotics when indicated 1
From the Research
Use of Fans in Patients with COPD Exacerbation
- Fans are used in patients' rooms when they are admitted for COPD exacerbation to help relieve breathlessness, as evidenced by studies 2, 3, 4.
- The use of hand-held fans has been shown to reduce breathlessness intensity and improve physical activity in patients with COPD 3.
- A systematic review of fan therapy for the treatment of dyspnea found that limited direct evidence from randomized controlled trials indicates that fan therapy may effectively alleviate dyspnea 4.
Mechanism of Action
- The exact mechanism of how fans relieve breathlessness is not fully understood, but it is thought to be related to the sensation of airflow on the face, which may help to reduce the sensation of breathlessness 2.
- The physical properties of fans, such as airflow velocity and blade rotation speed, can affect patient preference and perceived relief of breathlessness 2.
Clinical Practice
- Clinicians' beliefs about the benefits and mechanisms of fan therapy can influence its implementation in clinical practice 3.
- Barriers to implementation include a lack of clarity about whose role it is to implement the fan, what advice to provide patients, and limited access to fans in hospitals 3.
- The use of fans as a non-pharmacological intervention for chronic breathlessness in patients with COPD may require service- and clinician-level interventions to ensure its routine recommendation 3.