The patients in this study were randomly selected and consented during their attendance at either a COPD clinic or a routine appointment (non-respiratory related) at a General Practice comprising 11 medical practitioners serving 15,000 patients. All patients had been previously diagnosed with COPD with the same hand-held spirometer by the same general practitioner according to British Thoracic Society criteria [10]. Patients who consented were over the age of 65 and excluded if they had an upper respiratory tract infection within the preceding week, previous pulmonary surgery or active cardiac disease. We studied a group of 53 elderly patients with COPD (36 males) with a mean age of 73.5 (range 65–89) years. The investigator (SJ) was aware of the COPD diagnosis of the patients but blinded to the disease severity in each case and the spirometry indices were collected by the general practitioner separately.