Role of HRCT in Early Detection of Emphysema in Smokers with Normal Chest Radiograph

Background and Aims: Emphysema is a type of chronic obstructive pulmonary disease caused primarily by smoking. Early detection of emphysema in asymptomatic smokers is challenging, as conventional methods such as chest radiography and spirometry are not effective for identifying early-stage disease. High-resolution computed tomography (HRCT) has become a sensitive tool for detecting early emphysematous changes, particularly in smokers. Methodology: This hospital-based cross-sectional study included 50 asymptomatic smokers aged 25–50 years, all of whom smoked at least 5 cigarettes daily for over 5 years. Participants underwent clinical examination, chest radiography, spirometry, and HRCT scans (inspiratory and expiratory). The aim was to detect early emphysema in smokers with normal spirometry and radiographs. Results: Out of 50 subjects, 30 (60%) showed evidence of emphysema on HRCT. Air trapping was the most common finding (77%), followed by bullous emphysema (56%). Emphysema was predominantly found in the upper lung zones (60%). Air trapping was more frequent in subjects with a smoking history of more than 10 pack-years, while no emphysema was detected in subjects with fewer than 5-pack years. Conclusion: HRCT is a valuable tool for detecting early emphysema in asymptomatic smokers. The presence of air trapping on expiratory scans can serve as an early marker of emphysema, even when chest radiographs and spirometry appear normal. Early detection may help prevent further disease progression and improve patient outcomes.