A patient can know that an inhaler was prescribed and still be unsure why it matters on a day when breathing feels normal. This OET nursing asthma role-play teaches you to explore that gap before proposing reminders or repeating instructions. The patient also wants to exercise again after an episode of breathlessness, so the conversation must connect understanding, technique, symptom review and a usable personal plan.
This original teaching case follows the saved curriculum for OET Speaking for Nurses — Course 1, especially “The review of an inhaler routine”, “Asthma — condition study” and the communication lessons on concerns and checking understanding. The source available for this article is the course description and full curriculum outline, not a matching source book or full lesson transcript. The paired cards and extended model are original examples, not official examination material.
1. Your asthma review role-play cards
Nurse role card
Setting: A GP practice asthma review in England.
Situation: Maya Bennett, 29, has established asthma. Her current clinician-issued plan includes a daily preventer inhaler and a separate reliever. She sometimes skips the daily inhaler when she feels well. Three days ago she became breathless and wheezy during a jog, stopped and used her prescribed reliever according to her existing instructions; the symptoms settled. She is comfortable at rest today and has come to discuss the episode. She has brought both inhalers and her written plan. The card gives no medicine names, doses, device types, peak-flow readings or examination findings. Assess the history and understanding, review the actual plan and arrange appropriate clinical and technique review.
Your five tasks:
- Check Maya’s current breathing and explore the recent episode, other symptoms and how she uses her inhalers.
- Find out why she misses the daily inhaler and what most worries her about exercising again.
- Explain asthma and the purposes of the medicines in her prescribed plan, using plain language and checking understanding.
- Discuss a device-specific technique check and review the personal action plan, including worsening symptoms and emergency help.
- Agree a realistic next step that addresses the actual barrier, clarify what still needs clinical review and ask Maya to explain the plan back.
Patient role card
Setting: The same practice. You are Maya.
Situation: You generally feel well and thought the daily inhaler was needed only when the chest felt tight. You usually carry the reliever. The episode during your jog frightened you, even though it settled after you stopped and followed your existing reliever instructions. You are not breathless now. You have no supplied symptom frequency or peak-flow value. You brought the action plan but have not understood its different sections.
Your five tasks:
- Describe the jog and what you did, then explain how you use the two inhalers on an ordinary day.
- Reveal that skipping the daily inhaler is mainly about believing it is unnecessary when you feel normal, rather than simply forgetting.
- Ask why you need a daily medicine and whether having asthma means you should stop exercising permanently.
- Say the written plan is confusing and agree to a technique review without pretending you have already demonstrated the device correctly.
- Choose a useful next step with the nurse and explain what you would do on a usual day, if symptoms worsened and if emergency help was needed.
Partner briefing: Give the belief about feeling well only after the nurse explores it. Do not invent a dose or an unseen technique error. The nurse should recognise that a reminder alone does not explain why Maya needs the treatment she was prescribed.
2. Understand asthma before explaining the inhaler routine
What happens in the airways
Asthma is a long-term condition affecting the tubes that carry air through the lungs. These airways can become inflamed and narrowed, making breathing more difficult. Symptoms may include wheeze, cough, chest tightness and shortness of breath. They can vary over time, so someone may feel well between episodes.
That variation is central to Maya’s question. Feeling comfortable today does not, by itself, establish that a prescribed preventive treatment is no longer needed. Explain the purpose of the plan without implying that she should feel frightened whenever she has no symptoms. The aim is understanding, not anxiety.
The current prescription determines the explanation
In this particular case, the clinician has prescribed a daily preventer and a separate reliever. A steroid preventer reduces airway inflammation over time and is used regularly according to its instructions. The separate reliever has a role in responding to symptoms under the patient’s plan. Do not identify either medicine solely by an assumed colour.
Other asthma regimens exist. An anti-inflammatory reliever, or AIR, combines anti-inflammatory treatment with a fast-acting reliever and may be prescribed for use when symptoms occur. Maintenance and reliever therapy, or MART, uses a suitable combination inhaler both regularly and for relief according to the prescription. These are different plans, and not every combination inhaler can be used this way.
Therefore, do not turn Maya’s two-inhaler case into a rule for every person with asthma. Check the names, labels, device and current action plan. If treatment needs reconsidering, that is a clinical review decision. A speaking exercise should not switch the regimen or supply a dose that the card does not contain.
Explore the barrier before choosing a solution
Missing a medicine can reflect several different problems: misunderstanding its purpose, worries about effects, difficulty using the device, problems obtaining it or difficulty fitting it into a routine. Those explanations need different responses. In Maya’s first attempt, the central barrier is her belief that the daily inhaler is unnecessary when she feels well.
An alarm may help someone who intends to use a medicine but forgets. It does not resolve a belief that the medicine should not be used. Begin by asking what the patient thinks the inhaler does. Acknowledge the reasoning, explain the relevant point and then decide together whether any practical reminder is still needed.
Technique needs the actual device
Correct technique helps medicine reach the lungs. Devices differ in how they are prepared and how the person breathes in. A nurse, pharmacist or other appropriately trained clinician can watch the person’s usual method and provide specific teaching. Owning an inhaler for years does not establish that it is being used effectively.
Ask for a demonstration with permission and review the device instructions. Do not pretend to observe an error that the scenario has not shown. Do not give one breathing technique for every device, attach a spacer to an unsuitable device or announce that technique has been corrected when the exercise contains no demonstration.
Exercise is a goal to discuss, not automatically forbid
Physical activity can be beneficial, but cough, wheeze or chest tightness during exercise deserves review. Symptoms may relate to asthma control or triggers encountered during the activity. The history matters: what happened, when, what the patient did and whether symptoms occur at other times.
Maya’s episode should not lead to an unsupported promise that the next run will be safe or a blanket instruction to give up exercise. Review control, medicine use, technique and the personal plan with the appropriate clinician. Any advice about medicine before activity must come from that individual plan, not a guessed number of puffs.
Make the action plan understandable
A personal asthma action plan sets out the person’s usual treatment, how to respond to worsening symptoms and what to do during an attack. It needs to match the current regimen. Ask the patient to show the section they find confusing, work through the relevant instructions together and check what they would actually do.
New night waking, symptoms restricting usual activity or needing more relief should prompt advice and review. Emergency action is different from waiting for a routine appointment. In this English setting, call 999 during an asthma attack if symptoms worsen, the reliever is not helping after the prescribed maximum attack dose, or no reliever is available. Do not drive yourself to emergency care. Follow the personal plan and emergency call-handler’s instructions.
Case boundary: Maya is comfortable now, but the recent episode and treatment use still need review. The lesson does not establish her level of asthma control, declare an examination normal or give a return-to-running clearance.
3. Build the conversation from the five tasks
Task 1: Learn what happened before explaining why
Begin with the patient’s current breathing, then ask about the episode. An open invitation gives the sequence: “Tell me what happened during the jog.” Follow with focused questions about symptoms, response and other recent difficulties. Separate what the patient reports from findings that would require examination or testing.
Ask how each inhaler is used in an ordinary week. “Talk me through what you do” is more informative than “You use it properly, do you not?” Avoid inventing a symptom count because you think the model needs a neat number.
Task 2: Explore the reason behind the routine
When Maya says she skips the daily inhaler, resist moving straight to an alarm or calendar. Ask what leads to that decision. Her answer may change the entire explanation. In this case, she uses feeling well as a reason to believe the treatment is unnecessary.
Explore the exercise fear separately. She may be worried about an attack, embarrassment in front of others or not knowing what to do away from home. Reflect the actual concern you hear. Do not reduce every question to “You need to remember your medicine.”
Task 3: Explain one idea and check it
Use the actual plan to explain the medicine purposes. Keep the first explanation short enough for the patient to respond. Then ask a question that reveals meaning: “What does that tell you about a day when you feel well?” If she still thinks regular treatment is optional whenever symptoms disappear, clarify before moving on.
Avoid a lecture about every asthma medicine. The AIR and MART distinction belongs in the learner’s condition knowledge so they do not generalise wrongly. The patient conversation should focus on the regimen actually prescribed and any specific questions about it.
Task 4: Turn the plan into actions the patient can describe
Ask which part of the written plan is unclear. Work with that part, then distinguish ordinary care, worsening symptoms and an emergency. A plan is not usable merely because it has been handed over. The patient needs to know where to look and what the instructions mean.
Offer a device-specific technique review and explain why it is useful. In role-play practice, describe the next step honestly. You may invite a demonstration, but you should not praise a technique or correct an imaginary error that has not been supplied.
Task 5: Agree a next step that fits the identified barrier
Once the purpose is understood, ask whether anything else would make the routine difficult. A reminder can then be chosen if it addresses a real remaining problem. If the barrier is access or side effects, a reminder is unlikely to be the main answer.
Summarise the need to review the recent symptoms and technique, clarify the action plan and confirm any arrangements still pending. Ask Maya to explain her next action. A successful closing is a shared understanding of what happens next, not an invented appointment or a promise that symptoms cannot recur.
4. Extended nurse-only model with listening pauses
This is a study model longer than a timed five-minute role-play. Use it to learn how questions, explanations and checks fit together, then practise a shorter version. The responses come from the patient card; missing clinical details remain to be assessed.
“Hello, Maya. I’m the nurse seeing you for your asthma review. Before we begin, how is your breathing at the moment? If you are having difficulty now, we need to address that first.” [Pause; the patient reports being comfortable at rest.]
“Thank you. I understand the episode during your jog was frightening. Could you tell me what happened from the point when you first noticed a change in your breathing? I would like to hear the sequence in your own words.” [Listen.]
“You became breathless and wheezy, stopped running and followed your existing reliever instructions, after which the symptoms settled. Have I understood correctly? What happened afterward, and have you noticed symptoms at other times?” [Ask about relevant recent patterns without inventing a frequency.]
“I also want to ask whether breathing has disturbed your sleep, limited ordinary activities or led you to need more relief than usual. Those details help us understand what needs reviewing; feeling comfortable in this room does not answer all of those questions.” [Pause.]
“You have brought both inhalers and the written plan. Could you talk me through how you normally use each one? I would like to hear what happens on a day when you feel well as well as a day when you have symptoms.” [Listen to the routine.]
“You sometimes leave out the inhaler prescribed for daily use. What leads you to decide you do not need it that day? Is it mainly how your breathing feels, something about the medicine or a practical difficulty using it?” [Pause for the belief about feeling normal.]
“You thought it was only needed when your chest felt tight. I can see why a medicine’s purpose might seem unclear when it does not give an obvious immediate effect. Thank you for explaining; that tells me we need to clarify its job before discussing reminders.”
“What have you already been told about asthma and what happens in the airways? I can build on that and focus on the part that has not been clear.” [Pause.]
“Asthma affects the airways, the tubes carrying air through your lungs. They can become inflamed and narrowed, which can cause symptoms such as wheeze and breathlessness. Those symptoms can come and go, so a comfortable day does not necessarily mean the condition no longer needs treatment.”
“In the plan you have described, the daily preventer is intended to reduce inflammation over time. It is used as prescribed even on days when you feel well. The separate reliever has a different role in responding to symptoms under your instructions. Let us check the labels and the current written plan so we are discussing the right medicines.”
“Different people may have different inhaler plans, so I do not want you to copy a friend’s instructions or identify a medicine only by its colour. If your prescription needs changing, that needs a review with the appropriate clinician and an updated explanation.”
“Could you tell me what you now understand about the daily inhaler on a day when your breathing feels normal? This is to check that I have explained the purpose clearly.” [Listen; clarify any remaining misunderstanding.]
“You also asked whether you should stop exercising permanently. What worries you most about trying again? Is it the possibility of another episode, being away from help or something else?” [Pause rather than assuming the answer.]
“You are afraid of an attack while you are out running. That is an understandable concern after what happened. I would not want to dismiss it by saying the next run will definitely be fine. We should review the recent symptoms, your treatment use and technique, and make sure your plan is clear.”
“Having asthma does not automatically mean giving up activity. The aim is to help you be active with an appropriate plan for your asthma. I cannot give you personal clearance or extra inhaler instructions before the relevant review, but we can make your wish to exercise part of that discussion.”
“Would you be comfortable showing the clinician who checks your technique how you normally use each device? Inhalers can work differently. Watching your usual method helps identify what teaching, if any, is needed, rather than assuming that everyone needs the same instructions.” [Pause for agreement or questions.]
“I am not going to tell you that your technique is correct before it has been observed. We can use the actual device and its instructions, give you time to practise any relevant step and check it again. Is there a part of using either inhaler that already feels difficult?” [Listen.]
“Let us look at the action plan you brought. Which section is least clear to you? We can begin there rather than asking you to read the whole thing again on your own.” [Pause for the patient’s difficulty.]
“The plan should distinguish what you do routinely, what to do if symptoms worsen and what to do during an attack. We need to make sure it matches your current prescription. I will not guess the number of doses or a peak-flow threshold that is not in your individual instructions.”
“If symptoms are disturbing sleep, restricting usual activity or you need more relief than usual, that is a reason to seek advice and review. That is different from waiting until breathing becomes severely difficult. We should confirm the contact route you can use if the practice is closed.”
“During an asthma attack, if you become worse, the reliever is not helping after the maximum attack dose in your plan, or you have no reliever available, call 999. Do not drive yourself to emergency care. Follow your personal plan and the call-handler’s instructions rather than waiting for a routine appointment.”
“Could you show me where your plan explains the steps for worsening symptoms, and tell me what would make you call for emergency help? If the written instructions are unclear, we need to resolve that with you.” [Listen and clarify; do not assume a correct answer.]
“Now that we have discussed the purpose of the daily medicine, what might still make it difficult to follow the prescribed routine? If a reminder would help, we can choose one that fits your day. If the difficulty is something else, I would rather understand that than suggest an alarm that does not solve it.” [Pause.]
“Let me summarise the next steps: review the recent breathing episode and asthma control, check each device’s technique, and make the current action plan understandable. We will also address the routine barrier you identify. We have not changed your prescription or agreed a return-to-running date in this conversation.”
“In your own words, what will you do with your prescribed daily treatment, and what will you do if your breathing worsens? That will help us check the practical plan before we finish.” [Pause for the patient’s explanation.]
“Thank you. I want you to leave knowing what the next clinical steps are and how to get help, with your exercise goal included in the review. Is there another worry about the inhalers or the written plan that we have not addressed?” [Listen.]
5. Make the explanation an exchange
Use the patient’s reason in your response. If Maya says “I feel normal,” answer the relationship between symptoms and preventive treatment. If she says “I cannot work the device,” a different response is needed. A sentence that sounds caring but ignores the reason is not a complete answer.
Ask open questions before narrowing. Begin with what happened during the jog, then clarify the timing, symptoms and response. This helps avoid suggesting a cause before you have the story. Do not turn every question into a yes-or-no confirmation of your own assumptions.
Keep explanations short enough to interrupt. Explain one distinction, pause and invite a response. In study, the extended model shows several possible stages. In a timed exchange, use the stage the patient needs now rather than reciting all of them.
Use calm stress on the important contrast. In “even when you feel well”, make “feel well” clear without sounding scolding. In “your current plan”, stress that the instructions belong to this person. Pace and emphasis should make meaning easier to hear.
Check an action, not just agreement. “What would you do if that happened again?” tests whether the explanation can be used. It also lets you discover if the patient is planning to wait, take someone else’s medicine or follow an outdated instruction.
6. Useful sentences for the asthma review
| Purpose | Possible wording |
|---|---|
| Explore the episode | “Talk me through what happened before, during and after the breathlessness.” |
| Understand the routine | “What do you do with each inhaler on a day when you feel well?” |
| Find the belief | “What makes you decide the daily medicine is unnecessary that day?” |
| Acknowledge the fear | “That episode has made you worried about being active away from home.” |
| Explain the personal plan | “These medicines have different jobs in the plan you were prescribed.” |
| Invite a technique check | “Could you show how you normally use this device so we can check it together?” |
| Clarify the written information | “Which part of the plan would be hardest to follow if symptoms worsened?” |
| Choose a relevant next step | “What would make the agreed routine easier to follow in your day?” |
Practise changing the last sentence after a different answer. If the patient reports difficulty obtaining the inhaler, the next step is to explore access and the appropriate route for help, not simply to choose a reminder.
7. Common mistakes and repairs
Mistake: calling the patient forgetful before asking. “Set an alarm and be more careful.” Repair it by exploring what the inhaler means to the patient. A reminder addresses remembering, not misunderstanding, uncertainty or device difficulty.
Mistake: prescribing by colour. “Take two puffs of the blue one before every run.” Repair it by checking the actual medicine and personal instructions. The case gives no dose, and inhaler plans differ.
Mistake: declaring exercise unsafe or risk-free. “Never run again” and “You will be fine” both outrun the information. Repair it by acknowledging the goal and arranging the relevant review of symptoms, treatment and technique.
Mistake: treating a leaflet as understanding. “Everything is on the action plan.” Repair it by asking which part is unclear and checking a specific action after explanation. Possessing information is not the same as being able to use it.
Mistake: inventing a technique error. “You are inhaling too quickly” is unsupported until the method has been observed and the device identified. Repair it by inviting an appropriate demonstration and explaining what will be checked.
Mistake: leaving the emergency route vague. “Contact someone if it gets bad.” Repair it with a clear distinction between review for worsening control and emergency action during an attack. Tie medication steps to the current personal plan.
8. Second attempt: understanding is clear, but technique is uncertain
Repeat the consultation with a changed answer: “I understand why the daily inhaler matters, and I use it as prescribed. My worry is that I am not getting the medicine in properly.” Do not repeat the explanation as though the patient has again said treatment is unnecessary.
Your task: Acknowledge the different barrier, ask what feels difficult, arrange observation with the actual device and connect the technique check to the wider symptom review. Do not invent the device type or announce an error before observing it.
Open a suggested response and explanation
Suggested response: “Thank you for clarifying. You understand the purpose and are following the prescribed routine; the uncertainty is about using the device. Which step feels difficult, or what makes you think the medicine may not be reaching your lungs?” [Listen.]
“Would you be comfortable showing your usual method with the actual inhaler? We can check it against the instructions for that device and practise any step that needs attention. I will not assume the problem before seeing what happens. We should also keep the recent breathing symptoms in the clinical review, rather than deciding technique must be the only cause.”
Why it works: The response identifies the changed barrier and changes the next action. It respects what the patient already understands, avoids a generic demonstration and keeps the wider assessment in view. It does not claim that one technique correction guarantees future exercise safety.
Review your attempt: Find the first sentence after the changed answer. Does it mention the new concern? Did the nurse ask about the difficult step, or return to a memorised explanation about prevention? Did the ending distinguish a proposed check from a completed demonstration?
Third variation: The patient says, “I know what to do, but I have run out and cannot collect the repeat prescription today.” Explore current symptoms and the access problem, then discuss the appropriate same-day advice or supply route through the practice or pharmacy. Do not promise an unconfirmed supply or suggest borrowing another person’s inhaler. Acute breathing difficulty takes priority.
Continue with OET Speaking for Nurses — Course 1 and its related communication practice. In each attempt, give the partner one different reason for the same apparent behaviour. Your next step should change when the reason changes.
Clinical reading: NHS: asthma and emergency advice; NHLBI: what asthma is; Asthma + Lung UK on exercise, action plans, device-specific technique, steroid preventers, AIR and MART. Use the individual prescription and current clinical plan.
Your next step
OET Speaking for Nurses — Course 1
Explore the complete course outline and related practice topics.
Source: Course 1014 description and curriculum outline, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.