This is in response to the letter by Kako and colleagues. We appreciate their great interest in our publication, Rationale for Targeted Self-management Strategies for Breathlessness in Heart Failure and taking the time to raise their concerns. We would like to take this opportunity to respond to the issues raised in Mr. Kako’s notes.

In the letter to the editor, Mr. Kako noted, “The authors quoted Luckett T et al.’s study that use of a hand-held fan is effective in relieving breathlessness in 82% of the participants. We do not think this reference supports the author’s opinion, because the study does not mention fan therapy. However, there are some recent review articles about the effect of fan therapy on breathlessness, and we agree with the benefit of fan therapy.”

We would like to clarify that we referred to Luckett et al. [1] study on a use of hand-held fan; however, the wrong reference by the same authors from 2017 was being inserted in the original paper. In this paper, Luckett et al. make a reference to “hand-held fan” along with other modes of delivery of air, such as sitting in front of a fan or an open window to be just as effective” (2017). Since Luckette et al. study was based on a use of hand-held fan, we specified “the use of hand- held fan to be effective in relieving breathlessness in 82% of participants [1].” Moreover, the review articles mentioned by Mr. Kako have come out since our manuscript was prepared.

Mr. Kako also noted in the letter to the editor that “the type of fan may not limit the effects of fan therapy on breathlessness. For example, hand-held type, standing type, and desk type of fan have all been reported to be effective. Therefore, it is possible that not only sitting in front of a fan, but also lying on the bed and using a fan can have sufficient effects on breathlessness.”

We would like to emphasize that the more recent secondary exploratory analysis study has found 85% of the participants reported that a hand-held fan improved their breathlessness [2]. Furthermore, this study points out that in two randomized controlled trials, a fan-improved breathlessness compared with leg-directed airflow due to facial stimulation [2].