title: Inhaler technique of elderly patients: comparison of metered-dose inhalers and large volume spacer devices.
abstract: Large volume spacers (LVSs) reduce systemic absorption of steroid from metered-dose inhalers (MDIs) but there are no data to support the widespread belief that LVSs are easy for older people to use. MDI and LVS technique was examined in 40 inhaler-naive patients [19 men; 70-92 (mean 78.3) years] with chronic airways disease and mental test scores > 7/10. On day 1, technique was taught and errors corrected if possible. Technique was scored and patients asked which device they preferred. They were prescribed the device with which they were most competent. Those competent with both were given a device randomly. Technique was reassessed on day 29 without further tuition. On day 1 only three patients (8%) had inadequate technique for LVS vs. 12 (30%) for MDI (chi 2 = 6.90; p = 0.032). The main problems were inability to trigger the device (two patients with both devices), problems co-ordinating triggering and inhalation (20 patients with MDI), problems inserting the MDI into the LVS (seven patients), and unnecessary repetitive firing of the LVS (three patients); 28 (70%) preferred LVSs. On day 29, 29/30 (97%) with LVSs used them adequately, as did 13/15 (87%) using MDIs (five patients used both). LVSs have advantages over MDIs for elderly patients in terms of patient preference and inhaler technique.
authors.affiliation: Department of Geriatric Medicine, University of Manchester, Barnes Hospital, Cheadler, Cheshire.
authors.forename: M J
authors.initials: MJ
authors.lastname: Connolly
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*; D008297:Male; D009330:Nebulizers and Vaporizers
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents