A retrospective analysis of data from the Cardiovascular Health Study (CHS) performed by Mannino et al1 concludes that older adults with borderline abnormal spirometry results have an increased risk of death and hospitalisations related to chronic obstructive pulmonary disease (COPD). The all-cause mortality result from the analysis by Mannino et al merely confirms many previous reports.2 However, the mechanism is not obstructive lung disease since the vital capacity (FVC), aptly named by British surgeon John Hutchinson more than 150 years ago, is a stronger predictor than forced expiratory volume in 1 s (FEV₁),3 and respiratory …