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This will reduce deposition inside the spacer and increase the residence time.[52,53,54] The British Thoracic Society (BTS) guidelines recommend the use of an pMDI along with a spacer in preference to a nebulizer for the treatment of a mild-to-moderate acute asthma attack.[55] This approach was also supported by a Cochrane systematic review which found that nebulizers were not significantly any better than pMDIs.[56] Advantages of using a large-volume spacers include (a) better pattern of deposition resulting in more effective treatment and less side effects, (b) largely overcoming problems of poor inhaler technique if spacers are used properly, (c) easily used by children and elderly (except those with weak or arthritic hands), (d) as effective as a nebulizer in terms of treating acute attacks while being light, cheap, maintenance-free, portable, and available on prescription, (e) useful for the management of first attacks of wheezing in patients who have never used inhalers, (f) useful for the administration of bronchodilator when testing reversibility to establish the diagnosis of asthma, and (g) reduced prescribing cost through basing the treatment on the cheap pMDIs