BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) are of significant concern worldwide owing to their high prevalence and substantial clinical and economic burden. Adherence to inhaler may be evaluated by the specific inhaler adherence questionnaire, the Test of Adherence to Inhalers (TAI). OBJECTIVE: To assess the adherence profiles to inhaled therapies in COPD patients. SETTING: A 500 bedded tertiary care hospital in South India. METHOD: A prospective observational study was carried out in a tertiary care hospital in South India with a sample size of 150. MAIN OUTCOME MEASURE: To evaluate the adherence to inhalers in COPD patients and thereby taking measures to improve their adherence. RESULT: Among the study population 66% were males. The majority of patients (41.33%) were in the age group of 61-70 years. The present study shows that COPD was prevalent more in males than females. The elderly patients were at high risk of developing COPD. The non-adherence to inhalers were was associated with busy schedule, financial constraints and mood changes. CONCLUSION: Several factors may predict the incorrect use of inhalers or adherence in COPD outpatient, including the number of devices and the daily dosing frequency. Ideally, patient education, simplicity of the device operation, the use of just one device for multiple medications and the best adaptation of the patient to the inhaler should guide the physician in prescribing the device.