Respimat Piercing Element
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What is that piercing element for? It doesn't seem to touch anything, instructions and videos don't mention it except to say be careful not to touch it.
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It is there to open the cartridge that carries the medication. It is sealed for your safety and to prevent tampering, so the medication cannot be released, until the cartridge is pierced.
It is similar to a vial of medicine for injection and the person administering the dose must pierce the top of the sealed vial, in order to draw up the medication to administer it to themselves, or the relevant patient.
If you'd like, you can read more about this on the NIH and FDA websites.
Is there anything else I can help with?
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