METHODS: This prospective, observational cohort study enrolled patients seen in the outpatient pulmonary clinic at Henry Ford Hospital (HFH) from October 2015 to March 2016. Patients were included if they had a diagnosis of COPD or asthma, spoke English, and were 18 years of age or older. Patients were excluded if they presented for imaging results review, had a tracheostomy, or had a diagnosis of interstitial lung disease, sarcoidosis, or lung cancer. A pharmacist provided inhaler regimen recommendations to physicians based on objective VAIM assessments to help develop an individualized therapy plan. If the recommendations were accepted, the pharmacist then reviewed any inhaler changes with the patient. Follow-up phone calls were made at one and four weeks after the initial visit. The primary endpoint was asthma or COPD control as defined by changes in asthma control test (ACT) or COPD assessment test (CAT) scores, patient-reported symptoms, and weekly rescue inhaler use. Secondary endpoints included changes in patient adherence as measured by the Morisky Medication Adherence Scale (MMAS4) and to describe the utility of the VAIM in objectively assessing inhaler technique.