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

Context: High-flow nasal therapy (HFNT) may relieve severe dyspnea, but its role compared to other treatment options in palliative care remains unclear. Objectives: Assess the effect and feasibility of HFNT with air compared to fan therapy in relieving dyspnea among nonhypoxemic patients with incurable cancer. Methods: This prospective, randomized, controlled, crossover trial compared airflow delivered by HFNT and fan. The duration of both interventions was 30 minutes. Change in dyspnea was measured using a numeric rating scale (NRS) from 0 to 10. The overall benefits and adverse events of the interventions were assessed. (Trial identifier, NCT05257850). Results: Thirty-six patients with dyspnea on NRS ≥3, and oxygen saturation ≥88% were enrolled, and 28 patients completed the trial. The median NRS for dyspnea decreased from 5.0 (interquartile range [IQR] 4.0–6.5) to 3.5 (IQR 2.0–5.8, P = 0.001) with HFNT with air and from 5.0 (IQR 4.0–7.0) to 2.5 (IQR 1.0–7.0, P = 0.012) with fan. The median change in dyspnea on NRS was −1.0 (IQR 0.0 to −2.8) for both HFNT with air and fan, with no significant difference between the therapies (P = 0.935). Over half of the patients reported that both therapies relieved their dyspnea and that they adapted well to them. Conclusion: The effect of airflow through HFNT or fan on dyspnea did not differ in nonhypoxemic patients with advanced cancer. Both therapies seemed to give slight relief on dyspnea without significant adverse events. Thus, the choice between HFNT with air or fan should be made according to the patient´s preferences.