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Ershad Ahmad Mushkani,1 Fahima Hamidy,2 Tawfiq Ahmad,3 Mohammad Asef Adelyar4 1Department of Pharmacology, Kabul University of Medical Sciences, Kabul, Afghanistan; 2Department of Nursing Skills, Aliabad Teaching Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan; 3Department of Ophthalmology, Shahr Ara Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan; 4Department of Abdominal Surgery, Aliabad Teaching Hospital, Kabul University of Medical Sciences, Kabul, AfghanistanCorrespondence: Ershad Ahmad Mushkani, Department of Pharmacology, Kabul University of Medical Sciences, Kabul, Afghanistan, Tel +93-744600222, Email ershadahmad2605@gmail.comObjective: Evaluation of the techniques of respiratory inhaler use among stable inpatients with COPD in Ali Abad Teaching Hospital.Methods: This cross-sectional study was conducted between April 2020 and October 2022 at the cardiopulmonary department of Ali-Abad Teaching Hospital. Participants were requested to demonstrate how to use their prescribed inhalation devices. The inhaler’s accuracy was evaluated using checklists that had been previously established and included key procedures.Results: We studied 318 patients performing a total of 398 inhalation maneuvers with five different IDs. Across all studied inhalation maneuvers, the maximum number of misuses was observed in those using the Respimat (97.7%), and the minimum number of misuses was observed in those using the Accuhaler (58.8%). For the pMDI, the steps “take a deep breath after activating the inhaler” and “hold the breath a few seconds” were most frequently inaccurately performed. Regarding the pMDI with spacer, the steps “exhale fully” were most commonly carried out in mistake. For the Respimat, the steps “hold the breath a few seconds after inhalation activation” and “exhale fully” were most frequently inaccurately performed. According to gender, the misuse was less in females for all studied inhalers (p< 0.05). Higher proportion of literate participant correctly used all types of inhalers as compared to the illiterate patients (p< 0.05). According to the findings of this study, the majority of patients (77.6%) lacked knowledge of proper inhaler technique.Conclusion: The misuse rates were high for all studied inhalers; however, among studied inhalers, the Accuhaler had the greatest proportion of correct inhalation techniques. In order to ensure proper inhaler technique, patients should be educated before receiving inhaler medicines. Therefore, it is crucial for doctors, nurses, and other healthcare professionals to comprehend the problems with the performance and proper usage of these inhaler devices.Keywords: COPD, misuse, inhaler