The PLAB 2 Teaching Station: Inhaler Technique Step by Step

You’ve got seven minutes to teach a patient how to use their inhaler. The examiner is watching for structure, clarity, and whether the patient actually understands. The good news? Inhaler technique is one of the most predictable teaching stations in PLAB 2. If you break it down into three phases—set-up, demonstrate, check understanding—you’ll cover everything without rushing or missing key steps. Here’s how to do it, with the exact phrases and timing that work in the exam room.

Start by confirming the patient’s name and what they already know. This isn’t just courtesy—it tells the examiner you’re assessing baseline understanding. Say: “Before we start, can you tell me what you know about using your inhaler?” If they say “Nothing”, reply: “That’s fine, I’ll take you through it step by step.” If they mention shaking the inhaler or breathing out first, acknowledge it: “You’re right about shaking it—that’s important. Let’s go through the full technique together.” This takes about 30 seconds. Don’t skip it; it shows patient-centred communication.

Set-up: Positioning and Equipment

Place the inhaler on the table between you and the patient. If it’s a pressurised metered-dose inhaler (pMDI), say: “This is your blue reliever inhaler—salbutamol. We’ll use this one today.” If it’s a dry powder inhaler (DPI), like a Turbohaler or Accuhaler, name it: “This is your brown preventer inhaler—beclometasone. It’s a dry powder inhaler.” Hold it up and point to the mouthpiece. “The key parts are the mouthpiece here, and the dose counter here.” This takes 10 seconds and orients the patient.

Ask the patient to sit upright. “Can you sit up straight for me? Good. This helps the medicine reach your lungs.” If they’re slouching, gently adjust their posture. The examiner notes whether you consider ergonomics—it’s a small but important detail.

Demonstrate: The 6-Step Technique (pMDI Example)

Use the teach-back method: you demonstrate first, then the patient copies. For a pMDI, break it into six steps, using clear, numbered instructions. Say each step aloud as you do it, then ask the patient to repeat it. Here’s the script:

Remove the cap: “First, take the cap off and check the mouthpiece is clean.” Hold the inhaler upright. “See how I’m holding it? Thumb at the bottom, fingers on top.”
Shake well: “Shake it hard for five seconds—one, two, three, four, five.” Demonstrate the wrist flick.
Breathe out: “Breathe out gently, away from the inhaler, until your lungs feel empty.” Don’t rush this—pause for two seconds.
Seal lips: “Put the mouthpiece between your teeth and close your lips around it. Don’t bite—just a gentle seal.” Show them how to position their tongue flat.
Press and breathe in: “Press down on the canister once, and at the same time, breathe in slowly and deeply through your mouth. Like sipping a hot drink.” Press the canister as you say this.
Hold breath: “Hold your breath for five seconds—one, two, three, four, five—then breathe out normally.”

After demonstrating, hand the inhaler to the patient. “Now it’s your turn. Show me how you’d do it.” Watch closely. If they miss a step, correct it immediately: “You did the breathing in well. Next time, remember to shake it first.” Don’t let them rush—timing is tight, but accuracy matters more.

Dry Powder Inhalers: Key Differences

If it’s a DPI, the steps change. For a Turbohaler:

Twist the base: “Hold it upright and twist the base until you hear a click.”
Breathe out: “Breathe out gently, away from the inhaler.”
Seal lips: “Put the mouthpiece between your teeth and close your lips.”
Breathe in fast and deep: “Breathe in hard and fast—like blowing out a candle.” This is the opposite of a pMDI.
Hold breath: “Hold for five seconds, then breathe out.”

For an Accuhaler, the key difference is sliding the lever: “Push the lever back until it clicks. That loads the dose.” The rest is the same as the Turbohaler. Always name the inhaler type—examiners mark you down if you call a DPI a “puffer”.

Check Understanding: The 3-Question Rule

You’ve got about two minutes left. Use them to confirm the patient can repeat the steps and knows when to use the inhaler. Ask:

“Can you show me the steps again, in order?” Watch them do it. If they hesitate, prompt: “What’s the first thing you do?”
“When would you use this inhaler?” For salbutamol: “When you feel wheezy or short of breath.” For beclometasone: “Every day, even if you feel well.”
“What would you do if you used it and didn’t feel better?” Answer: “Wait five minutes, then take another dose. If you still feel unwell, call 999.”

If they answer all three correctly, say: “That’s perfect. You’ve got it.” If not, correct them: “Almost—remember, the brown inhaler is for daily use, not just when you’re breathless.”

Timing: The 7-Minute Breakdown

0:00–0:30: Introduce yourself, confirm name, ask what they know.
0:30–1:30: Set-up—name the inhaler, position the patient, show the parts.
1:30–4:00: Demonstrate the 6 steps (pMDI) or 5 steps (DPI).
4:00–6:00: Patient repeats the steps. Correct mistakes.
6:00–7:00: Check understanding with the 3 questions. Summarise.

Stick to this. If you’re running late, skip the “what they know” bit and jump to set-up. The examiner cares more about the demonstration and check-back than small talk.

Common Mistakes to Avoid

Not naming the inhaler type. Say “pressurised metered-dose inhaler” or “dry powder inhaler”. “Puffer” is too vague.
Rushing the breath-hold. Count “one, two, three, four, five” aloud. If you don’t, the patient won’t either.
Forgetting to check the dose counter. Point to it: “This tells you how many doses are left. When it’s in the red, you need a new one.”
Not correcting errors. If the patient breathes in too fast for a pMDI, say: “Slower next time—like sipping tea.”

Spacers: When to Mention Them

If the patient is a child or elderly, or if they’re using a steroid inhaler, add: “For this inhaler, a spacer can help. It’s a plastic tube that makes it easier to get the medicine into your lungs. Would you like me to show you how to use one?” The examiner may say “No, just the inhaler today”—that’s fine. Mentioning it shows you’re thinking about real-world use.

What the Examiner Wants to See

They’re marking you on four domains:

Introduction and rapport: Did you confirm the patient’s name and baseline knowledge?
Demonstration: Did you break it into clear steps and name the inhaler type?
Patient involvement: Did the patient repeat the steps? Did you correct errors?
Check understanding: Did you ask the 3 questions and confirm they knew when to use it?

If you hit all four, you’ll pass. The key is structure—set-up, demonstrate, check. Don’t improvise; follow the script.

Practice with Realistic Scenarios

In the exam, the patient might be:

A 7-year-old (use simple language: “Blow out like you’re blowing up a balloon”).
An elderly man with arthritis (offer a spacer or suggest a family member help).
A teenager who’s embarrassed (normalise it: “Lots of people find this tricky at first”).

For mock practice, try OSCEPilot—it generates timed teaching stations with actor responses, so you can rehearse the exact phrases and timing.

FAQ

1. What if the patient can’t repeat the steps? Break it down further. Say: “Let’s do just the first two steps together.” If they still struggle, offer a spacer or written instructions. In the exam, the actor will usually get it right after one correction—don’t panic.

2. Do I need to mention side effects? Only if the patient asks. If they do, keep it brief: “The blue inhaler can make your hands shake or your heart race, but that usually settles. The brown one can give you a sore throat—rinse your mouth after using it.”

3. What if I forget a step? The actor will usually prompt you. If they say “Do I shake it?”, reply: “Yes, that’s right—shake it for five seconds.” If you realise mid-demonstration, say: “I forgot to mention—before you breathe in, shake the inhaler.” Examiners are forgiving if you correct yourself.