The presence and severity of emphysema on computed tomography might recently be evaluated by a new spirometry-based assessment, the emphysema severity index (ESI). However, the index’s clinical usefulness has not been demonstrated.

To determine if ESI was linked with all-cause, respiratory, and non-respiratory 10-year mortality, researchers used Cox-regression models with adjustments for age, smoking, sex, forced expiratory volume in 1 s (FEV1), and forced vital capacity (FVC). All subjects with satisfactory spirometry from the Gott Aldrande i Skåne study, a Swedish general population aged 65-102 years old, were included in the research. ESI is stated as a continuous numeric parameter with a 0 to 10 scale. 

The final analysis includes 3,974 of the 4,453 individuals in the primary research. Age, ESI, FEV1, and male sex all raised the risk of respiratory mortality. ESI was linked with respiratory mortality but not non-respiratory death, whereas high age, male sex, and poor FEV1 were associated with both non-respiratory and respiratory death. Current smoking practices raised the risk of respiratory mortality but not significantly (P<0.066) One unit increase in ESI raised the risk of all-cause mortality by 20% (P<0.0002) and the risk of respiratory death by 57% (P< 0.0001). The ESI is a unique clinical measure of emphysema severity that is especially related with respiratory mortality.

Because it can be determined from routine spirometry, it has the potential to assist clinical practice by providing more personalized prognosis and treatment options.