The aim of this study was to observe how chronic obstructive pulmonary disease (COPD) is diagnosed and treated in primary care settings and to identify best practices. Researchers interviewed or visited physicians and staff at 25 primary care practices across the United States, focusing on small practices. All interviewers used a standard interview tool to capture anecdotal and quantitative data. It was discovered that primary care physicians underuse spirometry as a diagnostic tool, even when available in the office or clinic. Formal smoking-cessation programs are uncommon, as are outcomes measurements through clinical monitoring. Physicians reported not having enough time to improve performance, mainly owing to an average 15-minute patient visit allotment. Practice inefficiencies are responsible for many clinical shortcomings in COPD management. Although improving clinical understanding is important, it is equally important that overburdened and rushed primary care practices optimize workflow. This can be accomplished through better use of support staff and improved scheduling of spirometry testing in order to implement clinical guidelines without interfering with other essential practice tasks.