Exclusion Spirometry: A Bad Idea

No single item or combination of items from the bedside clinical examination can rule out airflow obstruction; for this purpose, spirometry is essential. I, like my colleagues, visually conceptualize chronic obstructive pulmonary disease patients using objective lung function testing. I am well aware that spirometry has neither been accepted nor widely performed outside of specialist practice (1). In this issue of the Canadian Respiratory Journal , Almirall and Bégin (pages 195 to 196) provide a very reasoned argument suggesting that obtaining isolated normal values of spirometric indexes can exclude certain conditions.