Diagnostic spirometry is key to supporting a clinical diagnosis of lung impairment. As a result of Covid-19, spirometry services in primary care were all but cancelled. There was much debate about the potential risks associated with spirometry as a potential aerosol generated procedure (AGP); clarity was needed for patients and staff. The evidence is now clearer, spirometry is not an AGP, although spirometry-associated cough has the potential to release airborne particles in the air, associated with an increased risk of transmission of harmful viruses such as Covid, influenza and the common cold. This article explores recent evidence to support the safe re-introduction of quality-assured spirometry in primary care, looking at how risks can be mitigated to try to readdress the backlog of diagnostic spirometry thought to be in the region of 200–250 patents per 500,00 population. Spirometry is important to reduce health inequalities for patients yet to have a diagnosis of lung disease.