Diagnosis and follow-up of emphysema

The definition of pulmonary emphysema is based on pathological examination. Clinical diagnosis is imprecise with no relationship between the extent of emphysema and either the "pink puffer" or the "blue bloater" types. The correlations between lung function tests and the extent of anatomically defined emphysema remain poor with a wide scatter. Plain chest radiograph is unreliable for the exclusion of emphysema whereas it is of value when positive. Major advance in the in vivo diagnosis has come from computed tomography (CT). It remains to be tested however whether serial quantitative CT scans will allow follow-up of the progression of emphysema.