Facial airflow enhances the benefits of exercise training in people with chronic lung disease: A randomized controlled trial

Introduction Breathlessness limits exercise training (ExT) intensity in people with chronic lung disease (CLD). Stimulation of the trigeminal nerve via fan-to-face (F2F) therapy (facial airflow) can reduce exertional breathlessness and improve exercise endurance in CLD. This randomized controlled trial tested the hypothesis that adding F2F therapy to an ExT program could enhance the benefits of ExT on exercise endurance time (EET) and exertional breathlessness in adults with CLD by allowing them to train at higher intensities. Methods Twenty-three participants with chronic obstructive pulmonary disease (n=19) or interstitial lung disease (n=4) were randomized to 5 weeks of thrice weekly supervised ExT with (F2F; n=12) or without (No Fan [NF]; n=11) facial airflow. Primary outcomes were baseline to post-ExT change in EET and iso-time breathlessness intensity ratings assessed using constant work-rate cardiopulmonary treadmill exercise testing. Results Cumulative ExT volume over the 5-week ExT program was similar in the F2F and NF groups, whereas breathlessness intensity ratings were consistently lower across all ExT sessions in the F2F group. Both the F2F and NF groups showed significant increases in EET (mean± sd 7.2±9.1 min, 95% CI[3.0, 13.6] versus 8.6±8.5 min, 95% CI[6.3, 9.0], respectively) and decreases in iso-time breathlessness intensity ratings (−2.1±1.5 min, 95% CI[0.6, 3.2] versus −1.5±1.1 min, 95% CI[0.8, 4.0], respectively) from baseline to post-ExT, with similar magnitudes of change observed between groups. Conclusion F2F therapy (facial airflow) is a simple, feasible, low-cost, low-resource non-pharmacological approach to reduce exertional breathlessness during an ExT program in people with CLD.