Chronic exposure to biomass smoke is a major contributor to obstructive respiratory disease in rural and resource-limited settings. In southern Costa Rica, many Indigenous Ngöbe-Buglé households rely on indoor wood-burning cooking fire, with minimal access to diagnostic tools or standard inhalation devices. This case illustrates how structural and environmental determinants shape the clinical management of chronic respiratory symptoms in a remote primary care context.In May 2025, a 65-year-old woman living in a home with an indoor wood cooking fire experienced a mild bronchospasm during a domiciliary primary care visit in an Indigenous Ngöbe-Buglé settlement. She had recurrent bronchospasm, with suspected chronic obstructive pathology linked to prolonged wood-smoke exposure. No complementary diagnostic tests or inhalation spacers were available. The episode was clinically oriented as mild bronchospasm based on symptom assessment, chest auscultation with a stethoscope, and normal peripheral oxygen saturation measured with a pulse oximeter. Inhaled therapy were indicated. An improvised inhalation chamber was constructed using a small plastic water bottle: a lateral opening was created to insert the inhaler, and the bottle’s mouthpiece served as the patient interface, reinforced with a bandage to reduce air leaks. Clinical information and photographs were collected with consent, focusing on relevant clinical and environmental information. Treatment was delivered despite material constraints, though the inability to confirm diagnosis or adress environmental triggers.Although improvised spacers have been described in low-resource environments, reports grounded in Indigenous home contexts in Central America are scarce. This provides insight into how environmental exposures and inequities affect respiratory care.The case highlights the need for adaptable, context-sensitive solutions in primary care. It emphasizes acknowledging environmental determinants, patient education, and ethical responsibility to provide equitable care in structurally disadvantaged settings. Such approaches may be transferable to other remote or underserved populations lacking chamber devices.This experience underscores the gap between ideal evidence-based management and the practical limitations of marginalized environments, encouraging reflection on feasibility, equity, and the clinician’s role in adapting care.The case illustrates persistent inequities and shows how primary care clinicians can deliver essential treatments through creative strategies, informing broader discussions on equity in global healthcare.