Can 'Mild Emphysema' on a Health Screening Report Be Ignored? [Health Check]

[Financial News] A study has found that the risk of death rises more than threefold when early emphysema is detected on a chest CT during a health screening and lung function is also impaired.
A research team comprising Park Hye Yun of Pulmonary Medicine, Lee Ho-yeon of Radiology, Danbee Kang of the Clinical Epidemiology Research Center, Hwang Jung Hye of the Health Medical Center at Samsung Medical Center, and Yoosoo Chang of the Cohort Research Institute at Kangbuk Samsung Hospital published the findings in CHEST, an international journal in the respiratory field with an impact factor of 10.2. The team analyzed adults who underwent low-dose chest CT and spirometry at the Samsung Medical Center Health Center between January 2010 and December 2019.
The researchers selected about 11% of the participants whose images could be analyzed at random, excluding those with a history of lung cancer, from among 50,596 people who had undergone comprehensive health screenings at Samsung Medical Center at least twice. A total of 5,276 people were included in the final analysis. Mortality was confirmed by linking the data to national death records, and the median follow-up period was 12.9 years.
Emphysema is a condition in which the air spaces become abnormally enlarged as the walls of the alveoli, the small air sacs in the lungs, are damaged. The research team defined early emphysema as an emphysema index known as LAA-950 of 1.5% or higher, as measured on chest CT. The 1.5% level was the average among participants in the screening population who had a history of smoking. Previous studies on chronic obstructive pulmonary disease (COPD) have mainly reported that an index of 5% or higher is associated with an increased risk of deterioration and death. The analysis found early emphysema in 18.7% of the participants, or 986 people.
Lee Ho-yeon explained, "Early emphysema is common among smokers, but because the changes in the measurements are mild and not pronounced, it is easy for both clinicians and patients to overlook. We need to identify early on which patients may actually progress to a dangerous condition requiring treatment; only then will prevention and treatment be possible."
This is why the research team combined the emphysema index with spirometry in its analysis. If the ratio of the amount exhaled during the first second to the total amount exhaled after taking a deep breath and breathing out fully, known as FEV1/FVC, was below 70%, the researchers classified the participant as having airflow limitation, a condition in which the airways are narrowed.
People with both early emphysema and airflow limitation had about 3.1 times the risk of death compared with those who had neither condition. By contrast, among those who had early emphysema without airflow limitation, the difference in mortality risk was not statistically significant compared with people who had neither condition.
Park Hye Yun said, "Seeing mild emphysema on a chest CT does not in itself mean that the condition is dangerous, but its significance changes when considered alongside spirometry. Along with an integrated approach that considers both tests, efforts are needed to prevent structural changes in the lungs and declines in lung function."


[email protected] Jung Myung-jin, Medical Specialist Reporter