BMJ 2001;322:577 ( 10 March )

Papers

Comparison of elderly people's technique in using two dry powder inhalers to deliver zanamivir: randomised controlled trial

Paul Diggory, consultant, ^a Christophe Fernandez, coordinator of medical audit, ^b Amanda Humphrey, specialist registrar, ^a Valerie Jones, consultant, ^a Maeve Murphy, specialist registrar. ^a

^a Department of Elderly Care Medicine, Mayday Hospital, Croydon CR7 7YE, ^b Department of Clinical Audit, Mayday Hospital

Correspondence to: P Diggory Pdiggory{at}aol.com

Objective: To determine whether elderly people can learn to use the inhaler used to deliver zanamivir (Relenza Diskhaler) as effectively as the Turbohaler and to identify which aspects of inhaler technique are most problematic.
Design: Randomised, controlled, intervention study.
Setting: Wards for acute elderly care in a large district general hospital.
Participants: 73 patients who were unfamiliar with the use of an inhaler, aged 71 to 99 (mean 83) years.
Main outcome measures: Initial scores and changes in scores 24 hours later using a 10 point scoring system of five aspects of inhaler technique.
Results: 38 patients were allocated the Relenza Diskhaler and 35 the Turbohaler. The mean total score was significantly greater in the Turbohaler than Diskhaler groups both initially (8.74 v 7.05) and after 24 hours (8.28 v 5.43). The major difference between inhalers was in loading and priming. After tuition 50% (19 of 38) of patients allocated the Diskhaler were unable to load and prime the device and 65% (24 of 37) were unable to do so 24 hours later. Of those allocated the Turbohaler, two patients were unable to load and prime the device after initial review and one after 24 hours.
Conclusion: Most elderly people cannot use the inhaler device used to deliver the anti-influenza drug zanamivir. Treatment with this drug is unlikely to be effective in elderly people unless the delivery system is improved.

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