COPD patient on Tiotropium Respimart divided into two group, Group A given aerochamber and Group B without aerochamber enroll in the study for total 18 week .

1. COPD patient who is on Tiotropium Respimart and other inhalers continued.
2. Those fullfill inclusion criteria will be randomized into two group.
3. To do Baseline CAT score and SGRQ questionnaires with Lung function test.
4. Assess inhaler technique with and without aerochamber.
5. Teach proper inhaler technique by templates and demonstrate to patients.
6. Group A given aerochamber and Group B without aerochamber enroll in the study for total 18 week .
7. First phase for 8 week after that 2 week of washout periode (without aerochamber both arm).
8. Then Group A without aerochamber and Group B with aerochamber continue with all inhalers for 8 week.
9. Followed up at 8th , 11th and 18th week to assess inhaler techniques ,Lung function test and do CAT score, and SGRQ questionnaire.
10. Analysis data

Inclusion Criteria:

1. COPD patients under Respiratory clinic UKM follow up

   • Patients who are with stable COPD (no exacerbation past 2 months)
   • Age same and more than 40-year-old

2. Patient able to perform inhaler medication

3. Patient able to perform technically acceptable pulmonary function test

Exclusion Criteria:

1. Drug hypersensitivity
2. Bronchial Asthma
3. Significant disease that may influence patient's ability to participate in the study.
4. Unable to provide signed informed consent
5. Mental condition rendering the subject unable to understand the nature, scope and the possible consequences of the study.