Introduction: Medication adherence improves symptoms and reduces exacerbation risk for COPD patients. Aims: To assess the impact of electronic reminders on adherence in COPD patients. Methods: The 6mo, open-label, randomized, multicenter, phase 4 study (NCT02864342) enrolled 137 patients aged ≥40y with ≥10 pack-year smoking history and moderate-to-very severe COPD in the US. Patients received BUD/FM pMDI 2 puffs of 160/4.5μg twice daily, BreatheMate device, and smartphone app (intervention group [INT, n=67] had audiovisual reminders; control group [CTRL, n=70] did not). The primary endpoint was the mean number of sets of adherent puffs/day (2 sets of 2 puffs/day, both puffs of a set within 60min, 4 puffs total) for 6mo. Secondary endpoints were Clinical COPD Questionnaire (CCQ) score, adherence for each 60d interval, usage days, and prescription refills. The study terminated early due to smartphone syncing issues. Results: INT had significantly more sets of adherent puffs/day (1.61 vs 1.33, P 2 sets of 2 puffs/day) days vs CTRL (P Conclusions: Use of the BreatheMate application with reminders resulted in significantly higher adherence to inhaled therapy in COPD patients. Funded by AstraZeneca