Clinical Significance of Radiologically Detected Emphysema in Young Adults Without Airflow Limitation

Although emphysema is typically associated with older age and the presence of airflow limitation, it can also be detected in young adults prior to the development of obstructive impairment. In this study, we aimed to investigate the relationship between the radiological characteristics of emphysema, pulmonary function test results, and symptom severity in patients aged 20 to 50 years who presented with complaints of dyspnea. In this retrospective study, patients with emphysema detected on computed tomography (CT) but without airflow limitation on spirometry were evaluated. Demographic characteristics, type and extent of emphysema, pulmonary function tests, and Modified Medical Research Council (mMRC) dyspnea scores were assessed. Patients were classified into preserved ratio impaired spirometry (PRISm) and pre-COPD groups, and these groups were compared in terms of clinical and symptomatic features. The mean age of the patients was 44 years, and 84.6% were male. The most common type of emphysema was paraseptal (43.6%), and the extent of emphysema was less than 5% in the majority of cases (78.4%). A negative correlation was found between the degree of emphysema and both FEV₁ (Forced Expiratory Volume in 1 Second) and FVC (Forced Vital Capacity), while a positive correlation was observed with the mMRC (Modified Medical Research Council) dyspnea score. Dyspnea was more pronounced in the PRISm group (p< 0.001). Emphysema detected in young adults without airflow limitation may have significant effects on symptom burden and pulmonary capacity. The PRISm phenotype, in particular, is notable for its association with increased symptom severity and a history of smoking, highlighting the importance of early identification of these individuals. Our findings underscore the value of early detection; however, further studies are needed to better understand the follow-up and management of this patient population.