A preliminary investigation of the hand-held fan and the Calming Hand for the management of chronic refractory breathlessness in patients with advanced malignant and non-malignant diseases

Swan, Flavia Eirwen Serena

July 2016

Thesis or dissertation

© 2016 Flavia Eirwen Serena Swan. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.

Background Chronic breathlessness is a devastating symptom of advanced cardio-respiratory diseases, with extensive consequences for patients and their family carers. Despite optimal management of the underlying disease, problems may persist. Non-pharmacological interventions such as the hand-held fan and the Calming Hand may offer benefits, however there is little supportive evidence.

Aim To gain preliminary data about the effectiveness of the hand-held fan and the Calming Hand for the management of exertion-induced breathlessness in people with chronic breathlessness.

Methods Mixed method study with integrated findings; Systematic literature review and meta-analyses of airflow; feasibility 2x2 factorial, randomised controlled trial of the handheld fan and/or Calming Hand for the relief of exertion-induced acute-on-chronic breathlessness. Qualitative interviews of patients and carers.

Findings Review findings indicate that airflow delivered from the hand-held fan at rest provides discernible breathlessness relief. The “2x2 factorial, pragmatic phase II trial of the Calming Hand and hand-held fan was feasible in terms of recruitment, data completion and trial acceptability. These preliminary results supported use of the fan for exertion-induced breathlessness including for time and rate of recovery after exertion-induced breathlessness. Qualitative data indicated that faster recovery improved patient self-efficacy and confidence. Patients identified the fan as a helpful “medical” device that played a useful role as part of a complex intervention for breathlessness. Conversely, there was little indication from quantitative or qualitative data to signal worthwhile benefit from the Calming Hand. The best candidate primary outcome measure was judged to be recovery rate or recovery time from exertion-induced breathlessness.

Conclusion A future definitive trial is feasible to assess the benefits of the hand-held fan with exertion induced breathlessness. Breathlessness recovery rate and the recovery time are novel outcomes that may potentially reflect important patient improvements with exercise. The hand-held fan represents a tool that helps to promote patient self-mastery of breathlessness. These data do not support the use of the Calming Hand.

Hull York Medical School, The University of Hull and University of York
Johnson, Miriam (Miriam J.)
Qualification level
Qualification name
3 MB
QR Code