Explain inhaler technique — pMDI with spacer

PLAB 2 & PRES 3 · respiratory · easy · 8 minutes

Candidate brief

You are a doctor in a GP asthma clinic. Ms Aisha Rahman, 34, has been prescribed a beclometasone pressurised metered-dose inhaler with a spacer. Her asthma nurse is concerned that she may not be using it correctly. Assess how she currently uses the inhaler, explain its purpose, teach the correct technique and check her understanding. No physical examination is required, but ensure that she is not currently experiencing an asthma attack.

What examiners look for

Always identify the exact inhaler and device before teaching technique. Pressurised metered-dose inhalers, dry-powder inhalers and breath-actuated inhalers are used differently. Ask the patient to demonstrate or describe their current technique before correcting it. For a pressurised metered-dose inhaler with a spacer: Remove the cap and inspect the mouthpiece. Shake the inhaler. Insert it into the spacer. Breathe out away from the spacer. Release one puff only. Breathe in slowly and steadily, or take 5 or 6 normal breaths if a single deep breath is difficult. Hold the breath for up to 10 seconds when possible. Shake and repeat the full process separately for another prescribed puff. A steroid-containing preventer should be taken regularly as prescribed, even when the patient feels well. Rinse the mouth and spit after use. Check technique at asthma reviews and after a device change. Use teach-back or return-demonstration rather than asking only, “Do you know how to use it?” Provide a personalised asthma action plan and explain when worsening symptoms require urgent or emergency help.

Guideline references

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