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A total of 122 COPD patients were included in this study, of whom 34 (27.9%) had suboptimal PIF. A total of 229 inhalers were tested, of which 186 (81.2%) were dry powder devices. The multivariate analysis found an association between suboptimal PIF and age (OR = 1.072; 95% CI (1.019, 1.128); = 0.007) and forced vital capacity (OR = 0.961; 95% CI (0.933, 0.989); = 0.006). About a third of patients in complex specialized COPD care have suboptimal PIFs, which is related to age and forced vital capacity. About a third of patients in comple
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