In developing countries like India and China, a sizeable population has past or present TB. Prevalence of TB infection is as high as 40% in India.2 Moreover TB may mimic bronchial asthma (eg, endobronchial TB may present with dyspnea and wheezing). In areas with high TB prevalence, physicians usually rule out TB in almost all patients presenting in chest clinics with any chest symptom. If spirometry is done in a case of pulmonary TB, it may infect the apparatus and spread the infection.3 Thus, as a silent policy it is considered unsafe to use spirometry without having a chest radiograph of the patient. If the radiograph findings suggest TB, which is not a rare scenario, sputum microscopy is required to rule out present active TB. This prolonged diagnostic protocol means more hospital visits and a delay in diagnosis and treatment. This delay is unacceptable when the patient is visibly in discomfort, which often is the case because patients present late in the course of disease. Understandably, physicians feel safer and more comfortable with starting treatment without spirometry than in taking a risk of the spread of infection. There is a need to develop a consensus statement regarding the use of spirometry in countries with a high TB prevalence.