Table 1.

Adherence to application technique (A-ApplT) – a brief description of the five steps for the different groups of inhalation systems used in chronic COPD patients (Five Steps Assessment). (http://chopn.registry.cz/index-en.php).

Step No.	Group of inhalation systems
	Aerosol inhalers (pMDI group)	Dry powder inhalers (DPI group)
1	Getting the inhaler ready for use (different for different types of inhalers)
	Remove the mouthpiece cover from the inhaler, and hold the device upright.	Insert a capsule with dry fingers into the chamber (capsule inhalers) and hold the device in correct position
2	Handling the inhaler before use (different for different types of inhalers)
	Shake well.	Press the piercing button(s), prepare a dose of drug (non-capsule inhalers).
3	Immediately before inhaling
	Breathe out completely in one breath (full and slow exhalation).
	Do not exhale into the device prior to actuating
4	Actual inhaling (different for different types of inhalation devices)
	While breathing in slowly (4–5 s) and deeply through your mouth, press down on the top of the inhaler with your thumb (press the button) to release a puff	Breathe in quickly and deeply.
5	Immediately after inhaling
	Take your inhaler device out of your mouth, hold your breath for several seconds and then breathe out very slowly, away from the inhaler.	Take your inhaler device out of your mouth, hold your breath for several seconds and then breathe out very slowly, away from the inhaler. Inhale twice to empty the capsule completely, close the mouthpiece and clean as needed.