The investigators looked at the effect that video instruction located at www.useinhalers.com would have on improving inhaler technique at a hospital in Guayaquil, Ecuador. The investigators compared this video instruction to written Spanish inhaler education. The investigators video taped participants before and after the intervention, and graded their technique on a pre-defined rubric.

Inclusion Criteria:

• Clinically-stable outpatient adults (≥18 years) with Asthma or Chronic Obstructive Pulmonary Disease (COPD) with history of at least one exacerbation in last 1 year
• Clinical diagnoses of asthma or COPD

Exclusion Criteria:

• Patients with language barrier (unable to understand and communicate in either English or Spanish)
• Cognitive or physical dysfunction that, in the investigator's opinion, would interfere with completion of the study
• Significant co-morbidity that can confound asthma symptoms - e.g. Congestive Heart Failure, current smoker, uncontrolled Gastroesophageal Reflux Disease, neuromuscular disease, chest wall deformity