Assess and correct a child's inhaler technique — OSCE

A nine-year-old girl with asthma attends a follow-up review. Her symptom scores have worsened over a term and her salbutamol reliever use has risen to most days. She takes a regular inhaled corticosteroid preventer and an inhaled corticosteroid-long-acting beta-agonist combination. On direct questioning she admits she often uses the preventer inhaler without the spacer because it is faster, and she does not always rinse her mouth afterwards. The nurse asks whether the preventer dose should be increased. You have eight minutes to assess the technique at the bedside, identify the delivery problems, defend a plan to correct them before escalating the drug, and explain the plan to the child and her parent.