Patients with suspected COPD, based on symptoms of chronic cough, sputum production or dyspnoea should have a spirometry, preferably with bronchodilator testing to determine persistent airflow limitation. The definition of persistent airflow limitation requires that the ratio of the forced expiratory volume in one second (FEV1) to the forced vital capacity (FVC) be less than 0.70 or a cut off of less than 95% of the lower limit of normal (LLN) can also be used (31). Measurement of diffusing capacity should be measured, as patients with HIV are more likely to have a decrease in diffusing capacity despite an otherwise normal spirometry (32). It is unclear exactly the reasons behind reduced DLCO in patients with HIV.  Screening spirometry to detect COPD in asymptomatic populations is not recommend. Case-finding to diagnose individuals who have symptoms and risk factors should be pursued (33). One study implementing screening spirometry in an outpatient clinic for PLWH found a high prevalence of symptoms and exposures consistent with COPD, and approximately one quarter of those who completed spirometry were diagnosed with COPD (34).