BACKGROUND: Patients with COPD have demonstrated poor adherence and persistence with inhaled maintenance medications, suggesting low satisfaction with existing therapies.  An understanding of the factors driving treatment satisfaction from the patient perspective is necessary to develop or modify therapies to address patients’ concerns.  OBJECTIVES: To examine factors influencing patients’ satisfaction with COPD maintenance medications.  METHODS: Fifty-two one-on-one semi-structured telephone interviews were conducted with COPD patients to gather information about attributes that influence satisfaction with COPD maintenance medication and delivery devices. Participants were selected from two sources: patients who recently exited one of two trials with aclidinium bromide via the Genuair™ inhaler(n=32) or non-trial patients recruited from clinics who recently received treatment with tiotropium bromide via the HandiHaler™(n=20).  A coding scheme for categorizing responses was developed and interview transcripts were analyzed using qualitative software.  RESULTS: Focus group participants had a mean age of 66.5 years; were 51.9% female; and had a diagnosis of moderate (GOLD II) to severe (GOLD III) COPD.  Four components of patients’ satisfaction were identified: ease of use/convenience, efficacy, onset of action, and side effects.  Regarding ease of use/convenience, patients most frequently cited the importance of device portability (31%), device simplicity (27%), and whether the device indicated that a dose had been received (25%).  For efficacy, patients most frequently mentioned whether the product made them feel that their airways were open and they could catch their breath (42%), that the medication kept symptoms from worsening (33%), and that the medication improved ambulatory ability (29%).  Nearly half of patients (46%) noted onset of action as important.  Finally, thirty-five percent of patients noted that side effects affected their satisfaction with treatment.  CONCLUSIONS: Ease of use/convenience, efficacy, onset of action, and side effects drive patients’ satisfaction with inhaled COPD maintenance medications.  COPD medications and delivery devices that address these factors may improve patient adherence and persistence.