Foreign body inhalation is rare in the adult population, and where clinical history is uncertain a high index of suspicion is warranted [1] . The typical clinical presentation of foreign body inhalation includes acute shortness of breath; cough; and wheeze. The majority of foreign bodies can be retrieved with flexible bronchoscopy, with rigid bronchoscopy a second-line option [2] . We report a case of a gentleman in his late 50's referred to respiratory two week wait clinic with a seven month

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... story of a productive cough, breathlessness and intermittent haemopytsis. Computed Tomography (CT) Thorax demonstrated a soft tissue lesion in the right bronchus intermedius with associated right middle and lower lobe collapse, suspected to be a primary lung malignancy. When reviewed in clinic he revealed that his symptoms started after taking his Salbutamol inhaler which he kept uncapped in his trouser pocket. On inhalation he experienced the sensation of something hitting the back of his throat. A flexible bronchoscopy revealed a foreign body in the right bronchus intermedius which was too embedded to be retrieved. He was referred to Thoracic surgery for rigid bronchoscopy who removed a tyre tube cap from the right bronchus intermedius which when shown to the patient he immediately recognised as his motorbike tyre tube cap. This case demonstrates the importance of inhaler technique education including incorporating inspection and re-capping of inhalers [3, 4] . We report our case due to its' unique features: a protracted diagnosis and an unusual presentation.