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.