Any elderly patient who smokes or has a history of smoking and demonstrates respiratory symptoms like chronic cough, shortness of breath, or physical activity limitations may have COPD. Spirometry testing is indicated to confirm the diagnosis of COPD and to determine the severity of the disease so that appropriate therapy can be initiated. Although most older people can perform spirometry adequately,8 some patients may be unable to perform this test (eg, patients with cognitive impairment, with limitations to vigorous respiratory efforts, sedation). Allen and Baxter9 evaluated four tests of cognition for their ability to predict inability to perform spirometry in a group of 113 subjects aged ≥70 (range 74–97) years. Only five of 57 (9%) subjects with a Mini-Mental State Examination score below the threshold for borderline cognitive impairment (Mini-Mental State Examination score