This study examined inter-community-based variations in spirometry parameters in 243 Aboriginal patients aged >18 years from 14 individual remote communities (61% female, with a median age of 54.6 years). Mixed ventilatory impairment was the most common pattern (51.6%), followed by restrictive (32.4%) and obstructive (9.8%). Significant inter-community variability was observed, ranging for mixed (85.7% to 37.5%), restrictive (62.5% to none) and obstructive (20% to none). These findings indicate a more tailored approach is needed to address lung health in rural and remote residing adult Aboriginal Australians.