title: A comparison of large volume spacer, breath-activated and dry powder inhalers in older people.
abstract: OBJECTIVE
  To see if elderly people can use the breath-activated (Easi-breathe) and dry powder (Turbohaler) inhalers as effectively as the metered-dose inhaler and Volumatic system.
  
  
  METHODS
  102 inhaler-naive patients (aged 75-101, mean 84 years), without cognitive impairment, were randomly allocated one of Easi-breathe, Turbohaler or metered-dose inhaler and Volumatic placebo inhalers. Standardized tuition was done on enrolment and at 6 h review. Inhaler technique was assessed immediately after enrolment tuition and at 6 and 24 h. Assessment was by scoring (0 = poor, 1 = moderate, 2 = perfect) five aspects of technique.
  
  
  RESULTS
  Mean total scores were significantly (P < 0.005) higher for Turbohaler and Easi-breathe than metered-dose inhaler and Volumatic on enrolment and 6 h and at 24 h (P < 0.045). Fewer patients achieved excellent scores of 9 or 10 when using metered-dose inhaler and Volumatic. The main difficulties were in assembling the metered-dose inhaler and Volumatic and detecting when the metered-dose inhaler and Volumatic or Easi-breathe was empty.
  
  
  CONCLUSIONS
  Breath-activated and dry powder inhalers were more likely to be used correctly than metered-dose inhalers with large volume spacers.
authors.affiliation: Department of Elderly Care Medicine, Mayday Hospital, Croydon, UK.
authors.forename: V
authors.initials: V
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Fernandez
authors.forename: P
authors.initials: P
authors.lastname: Diggory
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010353:Patient Education as Topic