Pulmonology · Medical Literature
The effect of handheld fans on dyspnea, illness perception, anxiety, and depression in patients with chronic obstructive pulmonary disease: A randomized controlled trial.
Abstract
Dyspnea, negative illness perceptions, anxiety, and depression are common problems that substantially impair quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD). This study aimed to evaluate the effects of handheld fan use on dyspnea, illness perception, anxiety, and depression in patients with COPD. A randomized controlled trial. Chest diseases clinic and polyclinic of a state hospital in eastern Türkiye. Patients with GOLD stage III-IV COPD. The handheld fan group received daily facial fan application for 15 min over six weeks, while the control group continued standard treatment and care. Participants were allocated using block randomization. Data were collected at baseline and at week 6 using the Patient Diagnosis Form, Visual Analog Scale, Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale. Researchers and the statistician were blinded. Paired and independent samples t-tests were used for within- and between-group comparisons. Fifty-nine participants were included in the final analysis (handheld fan group, n = 30; control group, n = 29). Baseline scores on all outcome measures were comparable between groups. Within-group analyses revealed significant reductions in dyspnea, anxiety, and depression in the handheld fan group, whereas no meaningful changes were observed in the control group. At the 6-week follow-up, between-group comparisons showed significantly lower dyspnea, anxiety, and depression scores in the handheld fan group. Significant differences were also observed in several Illness Perception Questionnaire subscales, including timeline (cyclical), personal control, treatment control, emotional representations, and psychological attributions. Handheld fan use significantly improved dyspnea, illness perception, anxiety, and depression in patients with stage III-IV COPD. This simple, low-cost intervention represents a practical adjunct to standard care and may enhance both physical and psychosocial outcomes in this population. ClinicalTrials.gov (NCT06857422). Registered 27 February 2025; first participant enrolled 28 February 2025.
Clinical relevance
In patients with GOLD stage III–IV COPD, does daily 15-minute handheld facial fan application for six weeks improve dyspnea, illness perception, anxiety, and depression compared with standard treatment alone? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (parallel group, assessor- and statistician-blinded)","setting":"Chest diseases clinic and polyclinic of a state hospital in eastern Türkiye","sampleSize":"n=59 (handheld fan group: n=30; control group: n=29)","population":"Adults with GOLD stage III–IV COPD; specific age, sex distribution, baseline lung function, and comorbidity data not reported in the available abstract","intervention":"Daily handheld fan directed to the face for 15 minutes per day over 6 weeks, in addition to standard treatment","comparator":"Standard COPD treatment and care only (no fan)","primaryOutcome":"Not explicitly designated as a single primary outcome in the available abstract; outcomes assessed were dyspnea (Visual Analog Scale), illness perception (Illness Perception Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale [HADS])","followUp":"6 weeks (baseline [T0] and post-intervention [T1] assessments)","fundingSource":"Ardahan University Scientific Research Projects Commission, Türkiye (non-profit/government academic body); no industry funding reported; no conflicts of interest declared"}
Key findings
The trial reported statistically significant improvements across all four outcome domains in the handheld fan group compared with the control group at 6 weeks. Baseline scores on all outcome measures were described as comparable between groups. Between-group effect sizes were reported as moderate-to-large: Cohen's d = 0.68 for dyspnea (VAS), d = 0.71 for anxiety (HADS), and d = 0.73 for depression (HADS); the effect size for illness perception was not reported in the available abstract. Specific absolute score changes, confidence intervals, and exact p-values for between-group comparisons are not reported in the available abstract and therefore cannot be verified. NNT cannot be calculated from the data available. No adverse events related to the intervention were described. Adherence monitoring methods and objective physiological outcomes (e.g., SpO₂, FEV₁) were not reported.
Practice implications
This single-center RCT provides evidence that a simple, low-cost, non-pharmacological intervention — daily 15-minute facial airflow using a handheld fan — produces moderate-to-large improvements in dyspnea severity, illness perception, anxiety, and depression over six weeks in patients with severe-to-very-severe COPD (GOLD III–IV). The biological plausibility is supported by prior evidence that facial airflow activates V2 trigeminal afferents, modulating the perception of breathlessness without altering oxygenation or ventilation. However, several important caveats apply. First, only the abstract (truncated) was available for review; raw data, confidence intervals, and exact p-values were not extractable, preventing independent verification of the effect estimates. Second, whether the observed scale-score improvements exceed established minimal clinically important differences (MCIDs) for these instruments in COPD cannot be confirmed from the available data. Third, the trial enrolled exclusively GOLD III–IV patients in a single state hospital in eastern Türkiye, limiting generalizability to milder COPD, other geographic or healthcare contexts, and populations with differing comorbidity profiles. Fourth, participants in the control group were not sham-controlled (e.g., fan directed to the leg), introducing the possibility that attention, expectation, and therapeutic contact contributed to the observed psychosocial outcomes. Fifth, the 6-week follow-up does not establish durability of benefit. The findings are consistent with prior RCT and observational evidence supporting handheld fan use for dyspnea relief, and they extend the literature by quantifying psychosocial outcomes in this population. __LIMITATIONS__ Small sample size (n=59) limits statistical power and precision; confidence intervals were not reported in the available abstract,Single-center design in eastern Türkiye restricts generalizability to other healthcare systems and populations,No sham or active comparator for the control group (e.g., fan directed to the leg), introducing performance and expectation bias for patient-reported psychosocial outcomes,Participants and intervention-deliverers could not be blinded to group allocation, a fundamental limitation for subjective outcomes such as dyspnea and mood,Only 6 weeks of follow-up; long-term durability of benefit, optimal frequency, and dose of fan use are unknown,No MCID thresholds explicitly applied to determine clinical significance of scale-score changes for VAS-dyspnea, IPQ, or HADS in this context,Adherence to the daily fan protocol was not objectively measured or reported,No objective pulmonary function, exercise capacity, or physiological endpoints (SpO₂, heart rate) were co-assessed to elucidate mechanism,Exclusive enrollment of GOLD III–IV patients limits applicability to milder COPD stages,Trial was retrospectively registered (first participant enrolled same day as registration date of 27 February 2025), which introduces risk of outcome reporting bias,Full data tables, confidence intervals, and exact p-values are not available from the abstract alone, preventing complete independent appraisal __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ In patients with severe-to-very-severe COPD (GOLD III–IV), six weeks of daily 15-minute handheld facial fan use produced statistically significant, moderate-to-large improvements in dyspnea, illness perception, anxiety, and depression compared with standard care alone, with Cohen's d ranging from 0.68 to 0.73 across domains. Given the intervention's negligible cost, favorable safety profile, and biological plausibility, it represents a reasonable adjunctive non-pharmacological option in this population, particularly for symptom burden management. Confirmation in larger, sham-controlled, multicenter trials with longer follow-up and MCID-referenced outcomes is needed before this practice can be broadly recommended.