METHODS: 23 physician-diagnosed patients (19 asthma, 4 COPD, 6 male, 17 female, aged 20-65) were recruited in the study from the Pulmonary Function Lab of Ben Taub General Hospital in Houston, Texas. Each patient was given a placebo MDI attached to the CapMedic device. CapMedic is a small electronic cap attached to the MDI canister that passively records the following seven MDI steps: number of MDI shakes before actuation, coordination (time, in seconds, of actuating MDI after start of inhalation), mean inspiratory flowrate (L/min), number of actuations per inhalation, duration of inspiration (in seconds), orientation of inhaler during actuation (angle from the vertical position, in degrees), and number of incorrect exhalations post actuation. The clinical staff conducting the study also recorded the same parameters qualitatively by observation using a checklist, using binary answers based on guidelines (correct/incorrect). Furthermore, due to limitations of the device, the staff could record an additional parameter of breath hold after inhalation.