Your doctor will ask for details about your smoking. He or she will ask how long you've smoked, and how many cigarettes per day.
Other questions may include:
Do you breathe passive (secondhand) smoke at work or at home?
Do you live or work in an area where you are exposed to airborne irritants or noxious materials?
Do you live in an area with significant air pollution?
Is there a family history of:
Early onset of emphysema
Non-smokers who developed emphysema
Your doctor also will ask about your respiratory symptoms. He or she will want to know if and when you develop shortness of breath. The doctor also may wish to ask about:
Recurrent bad colds
A persistent, heavy cough
Your doctor then will examine you to look for typical signs of emphysema. This may include:
Watching for shortness of breath when you perform simple activities, such as walking into the exam room
Looking at the size and shape of your chest
Looking at how your chest moves when you breathe
Listening to your lungs for wheezing or loss of the normal breath sounds
Checking your ears, nose and throat for reasons why you may be coughing
Listening to your heart
Checking your skin, lips and fingernails for a bluish tint that indicates low blood oxygen levels. (Your doctor also may directly measure your blood oxygen level with a finger probe known as an oximeter.)
Checking your fingernails for an unusual curvature ("clubbing") that sometimes occurs with chronic lung disease
Feeling your ankles for swelling that indicates fluid accumulation
The results of this examination may be totally normal in many people in the earliest stages of emphysema.
In most people, emphysema will be diagnosed by X-ray or lung-function tests.
A regular chest X-ray may show typical changes of emphysema. These include:
Enlargement of the lungs
Formation of holes (bullae)
However, these changes may not appear until significant damage has occurred. Computed tomography (CT) scans are better for detecting the earliest changes of emphysema. CT scans may help to diagnose the disease in younger people or those who have never smoked.
Pulmonary function testing is useful both to diagnose emphysema and to determine the stage of the disease. This test is also known as spirometry. In this test you will blow forcefully through a tube. The tube is connected to a machine that measures your lung capacity.
Your doctor also may order specialized lung tests. These may require you to sit inside a glass box, or slowly breathe in a mixture of different gases.
Other tests your doctor may order include:
Arterial blood gases. Measures the levels of oxygen and carbon dioxide in your blood. The blood is taken by a needle from a small artery in the wrist.
Electrocardiogram (EKG). Looks for evidence of heart problems that may cause more shortness of breath than emphysema alone. An EKG also looks for heart strain caused by emphysema.
If suspected, your doctor can order a blood test to confirm the diagnosis of AAT deficiency. If this test is positive, your doctor may recommend screening for your entire family.