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Pulmonary Emphysema - Diagnosis
Last reviewed: 04.07.2025
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Study of the function of external respiration. The most characteristic sign of primary pulmonary emphysema is a decrease in the vital capacity of the lungs (VC) and an increase in the total lung capacity (TLC), residual volume of the lungs (RVL).
Total lung capacity (TLC) is the total volume of air in the chest after a maximal inspiration.
Residual volume is the volume of air remaining in the lungs at the end of maximal expiration.
As emphysema progresses, bronchial obstruction occurs, which is manifested by a decrease in FVC, Tiffno index, MVL, and a sharp decrease in peak flowmetry indicators. In secondary pulmonary emphysema, the impairment of bronchial patency is much more pronounced.
The prognosis of patients with secondary pulmonary emphysema is determined by the severity of bronchial obstruction, arterial hypoxemia, hypercapnia, and pulmonary hypertension. It is recommended to conduct tests using bronchodilators to identify the reversible and irreversible nature of bronchial obstruction. In patients with pulmonary emphysema, obstruction is persistent and irreversible, and in chronic obstructive bronchitis, a partial bronchodilating effect is noted.
Complete blood count. Patients with pulmonary emphysema tend to have increased red blood cell counts and hemoglobin levels, especially with the development of respiratory failure.
ECG. In pulmonary emphysema, there is a deviation of the electrical axis of the heart to the right, a rotation of the heart around the longitudinal axis clockwise (deep S waves are significantly expressed not only in the right, but also in the left chest leads).
Changes in the tension of oxygen and carbon dioxide in the blood. In patients with primary emphysema, the partial tension of oxygen remains normal in the initial stages of the disease; with the development of respiratory failure, PaO2 decreases; in advanced stages, PaCO2 increases. In patients with secondary emphysema, with pronounced broncho-obstructive syndrome, PaO2 decreases quite quickly and PaCO2 increases.
Chronic obstructive bronchitis and pulmonary emphysema usually always accompany each other, especially in the advanced stage of the disease, when it is extremely difficult to differentiate between these two diseases. Therefore, in such a situation, it is preferable to talk about chronic obstructive pulmonary disease with a predominance of pulmonary emphysema or chronic bronchitis. Accordingly, two types of COPD are distinguished: type A - emphysematous (short-breath, "pink puffing"), type B - bronchitis (coughing, cyanotic).