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Q&A with Australian Health Practitioners
How is emphysema diagnosed?
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Dr Samantha Herath
Respiratory & Sleep Medicine Physician
Dr Samantha Herath completed her Respiratory and Sleep Medicine training in New Zealand, Australia and Canada. She has extensive post-fellowship, sub-speciality training in Sleep Medicine … View Profile
Emphysema is one form of chronic obstructive airways disease. The commonest cause of emphysema is smoking. However, non-smokers can develop emphysema due to a genetic condition called alpha one antitrypsin deficiency. There are also other causes like exposure to smoke in confined spaces that could cause emphysema in nonsmokers.
Also, it is important to remember that damage caused by smoking is permanent. Therefore even if you have stopped smoking many years ago, you could still develop emphysema due to the smoking.
The diagnosis of emphysema is made in combination of three aspects:
1. Clinical features: Wheeze/shortness of breath/recurrent chest infections/smokers cough, etc
Together with this a past or present history of smoking and family history of emphysema as well as family history of alpha one antitrypsin deficiency is important.
2. Spirometry/lung function: This is a functional measure of your lung capacity done via a simple breathing test. This test is offered by some general practitioners and generally all Respiratory Physicians. This test is very technique and effort dependent. Therefore, the test should be done by a qualified medical doctor or a Respiratory scientist only.
In this spirometry test there are two parameters to look at:
1. The absolute numbers showing an OBSTRUCTIVE DEFECT
2. Flow volume loop graph demonstrating a "scooping in" of the expiratory arm.
The test of course, must be interpreted by a Respiratory Physician.
3. The third measure is radiology. This is either a chest X-ray or CT scan of the chest. The chest
er a chest X-ray or CT scan of the chest. The chest X ray will generally show lungs too expanded with trapped air called "hyper inflation".
The CT scan of the chest is more informative showing typical changes of emphysema. This is large sacs of air replacing the millions of lung alveoli or gas exchange units due to the harmful effects of smoking or fumes that breaks down the communicating walls and form useless air-filled sacs.
I usually check the alpha one anti trypsin levels in all non-smokers as well. Also, it is my practice to obtain a high-resolution CT scan of the chest in every patient suspected of emphysema or COPD at the initial visit so that I have a greater understanding of the patients condition.
Therefore, if you feels there is a possibility you have emphysema please ask your doctor to refer you to a Respiratory Physician for investigation. Sooner the diagnosis is made sooner you can be commenced on treatment, if required. Also remember that many other conditions like chronic asthma, chronic bronchiectasis can also present with similar clinical features, therefore a thorough assessment by a specialist is required to make a diagnosis.
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