Airflow relieves chronic breathlessness in people with advanced disease: An exploratory systematic review and meta-analyses

TY - JOUR

T1 - Airflow relieves chronic breathlessness in people with advanced disease

T2 - An exploratory systematic review and meta-analyses

AU - Swan, Flavia

AU - Newey, Alison

AU - Bland, Martin

AU - Allgar, Victoria

AU - Booth, Sara

AU - Bausewein, Claudia

AU - Yorke, Janelle

AU - Johnson, Miriam

N1 - © The Author(s) 2019. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - BACKGROUND:: Chronic breathlessness is a neglected symptom of advanced diseases.AIM:: To examine the effect of airflow for chronic breathlessness relief.DESIGN:: Exploratory systematic review and meta-analysis.DATA SOURCES:: Medline, CINAHL, AMED and Cochrane databases were searched (1985-2018) for observational studies or randomised controlled trials of airflow as intervention or comparator. Selection against predefined inclusion criteria, quality appraisal and data extraction was conducted by two independent reviewers with access to a third for unresolved differences. 'Before and after' breathlessness measures from airflow arms were analysed. Meta-analysis was carried out where possible.RESULTS:: In all, 16 of 78 studies (n = 929) were included: 11 randomised controlled trials of oxygen versus medical air, 4 randomised controlled trials and 1 fan cohort study. Three meta-analyses were possible: (1) Fan at rest in three studies (n = 111) offered significant benefit for breathlessness intensity (0-100 mm visual analogue scale and 0-10 numerical rating scale), mean difference -11.17 (95% confidence intervals (CI) -16.60 to -5.74), p = 0.06 I2 64%. (2) Medical air via nasal cannulae at rest in two studies (n = 89) improved breathlessness intensity (visual analogue scale), mean difference -12.0 mm, 95% CI -7.4 to -16.6, p < 0.0001 I2 = 0%. (3) Medical airflow during a constant load exercise test before and after rehabilitation (n = 29) in two studies improved breathlessness intensity (modified Borg scale, 0-10), mean difference -2.9, 95% CI -3.2 to -2.7, p < 0.0001 I2 = 0%.CONCLUSION:: Airflow appears to offer meaningful relief of chronic breathlessness and should be considered as an adjunct treatment in the management of breathlessness.

AB - BACKGROUND:: Chronic breathlessness is a neglected symptom of advanced diseases.AIM:: To examine the effect of airflow for chronic breathlessness relief.DESIGN:: Exploratory systematic review and meta-analysis.DATA SOURCES:: Medline, CINAHL, AMED and Cochrane databases were searched (1985-2018) for observational studies or randomised controlled trials of airflow as intervention or comparator. Selection against predefined inclusion criteria, quality appraisal and data extraction was conducted by two independent reviewers with access to a third for unresolved differences. 'Before and after' breathlessness measures from airflow arms were analysed. Meta-analysis was carried out where possible.RESULTS:: In all, 16 of 78 studies (n = 929) were included: 11 randomised controlled trials of oxygen versus medical air, 4 randomised controlled trials and 1 fan cohort study. Three meta-analyses were possible: (1) Fan at rest in three studies (n = 111) offered significant benefit for breathlessness intensity (0-100 mm visual analogue scale and 0-10 numerical rating scale), mean difference -11.17 (95% confidence intervals (CI) -16.60 to -5.74), p = 0.06 I2 64%. (2) Medical air via nasal cannulae at rest in two studies (n = 89) improved breathlessness intensity (visual analogue scale), mean difference -12.0 mm, 95% CI -7.4 to -16.6, p < 0.0001 I2 = 0%. (3) Medical airflow during a constant load exercise test before and after rehabilitation (n = 29) in two studies improved breathlessness intensity (modified Borg scale, 0-10), mean difference -2.9, 95% CI -3.2 to -2.7, p < 0.0001 I2 = 0%.CONCLUSION:: Airflow appears to offer meaningful relief of chronic breathlessness and should be considered as an adjunct treatment in the management of breathlessness.

KW - Dyspnoea

KW - airflow (relevant term as the intervention subject heading)

KW - review

KW - self-management

UR - http://www.scopus.com/inward/record.url?scp=85062655297&partnerID=8YFLogxK

U2 - 10.1177/0269216319835393

DO - 10.1177/0269216319835393

M3 - Article

C2 - 30848701

SN - 0269-2163

VL - 33

SP - 618

EP - 633

JO - Palliative Medicine

JF - Palliative Medicine

IS - 6

M1 - 269216319835393

ER -