Management of Dyspnea With High-Flow Nasal Air or Fan-A Randomized Controlled Crossover Trial

1. In patients with advanced cancer who are not hypoxemic, high-flow nasal therapy using room air and simple fan therapy provide safe, similar, and modest relief of dyspnea.

2. Because both treatments are safe, feasible, and equally effective, the choice of therapy should be guided by patient comfort, preference, and ease of use.

Evidence Rating Level: 2 (Good) 

Dyspnea is a common and distressing symptom in patients with advanced cancer, and while airflow-based therapies can provide relief, the comparative role of high-flow nasal therapy (HFNT) with room air versus simple fan therapy in nonhypoxemic patients remains uncertain. This prospective, randomized, controlled crossover trial evaluated the efficacy and feasibility of HFNT with air compared with fan therapy in relieving dyspnea among adults with incurable cancer and oxygen saturation ≥88%. Thirty-six patients with moderate dyspnea (numeric rating scale [NRS] ≥3) were enrolled, and 28 completed both interventions. Participants received 30 minutes of HFNT with room air and 30 minutes of fan therapy in randomized order, separated by a washout period. Both interventions resulted in statistically significant but modest reductions in dyspnea. Median dyspnea scores decreased from 5.0 to 3.5 with HFNT and from 5.0 to 2.5 with fan therapy. The median change in dyspnea was −1.0 NRS points for both treatments, with no significant difference between them. Over half of patients reported subjective dyspnea relief and good adaptation to each therapy. Adverse events were minimal, and no serious events occurred. The study concludes that HFNT with room air offers no advantage over fan therapy for dyspnea relief in nonhypoxemic patients with advanced cancer. Both modalities are feasible, safe, and provide mild symptom relief, supporting individualized, preference-based selection.

Click here to read this study in the Journal of Pain and Symptom Management

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