Chronic obstructive pulmonary disease (COPD) is a major public health problem. The use of spirometry for early detection of COPD is a current issue of debate because of lack of convincing evidence of the additional positive effect of spirometry on smoking cessation. In this article, we present conditions under which early detection of COPD and confrontation may be effective, highlighting the principles of "confrontational counselling". Confronting patients with COPD is not an isolated approach but should be integrated into state-of-the-art smoking cessation treatment. Confrontational counselling should consist of several counselling sessions on an individual, face-to-face level, under supervision of a trained smoking cessation specialist, and in combination with evidence-based pharmacological treatment for smoking cessation.