Test ESI, Emphysema Severity Index

ESI (Emphysema Severity Index): Test for the assessment of emphysema in smokers, ex smokers and patients with BPCO


The ESI-test is performed calculating a quantitative score (0-10) reflecting the severity of emphysema. The calculator is derived by a biomechanic mathematical model developed after 10 years of research  and experiments.

The analysis is based uniquely on data derived by standard spirometry without any standardization or normalization (i.e. % pred. or LLN, z-scores, etc.).

The ESI test application software is freely available for research projects and research partnerships.

Emphysema in smokers and COPD

According to WHO (World Health Organization): “Chronic Obstructive Pulmonary Disease (COPD) is not one single disease but an umbrella term used to describe chronic lung diseases that cause airflow obstruction. The more familiar terms ‘chronic bronchitis‘ and ‘emphysema‘ are no longer used, but are now included within the COPD diagnosis.” According to the recent estimates, currently 64 million people have COPD and 3 million people died of COPD. WHO predicts that COPD will become the third leading cause of death worldwide by 2030. Chronic obstructive pulmonary disease (COPD) is a complex condition with a wide spectrum of clinical presentations and pathological features unified under the spirometric definition of airflow obstruction. Airway narrowing and parenchymal destruction are recognized as the mechanisms responsible for airflow obstruction in COPD, but they cannot be distinguished by standard spirometry indexes such as FEV1 (%pred) or FEV1/FVC.

ESI platform

ESI digital platform
ESI test digital platform

The ESI – test digital platform

emphysema . app is the access point to the ESI digital platform. The ESI test for the assessment of emphysema is directly accessible by PC or Mac, laptops, smartphones or tablets via standard browsers.

Furthermore, it’s possible to establish custom on demand data connections with any digital clinical instrumentation (laboratory spirometry, portable spirometers, PFTs setup, etc…).

Batch analysis tool is available for the calculation of ESI in large datasets and to perform multiple tests.

Automated analysis

The on-line ESI test provides automatically a digital report containing numeric tables and graphics to better understand the ESI test output.

Simple use

To perform the ESI – test is required a reduced set of flow-volume data acquired during standard spirometry. The required data are usually available in the output reports provided by common spirometers. The output results are provided to the user directly through the web based interface and a standard report can be saved or printed on local client devices.

ESI – test Automated Reports

ESI test report example

Custom test output reports or data integration / interoperability with other systems or medical equipment is available on request for research projects.



CT-based validation of the ESI – test for the assessment of emphysema by spirometry

The advanced clinical experimentation of the ESI theory was performed using dedicated math software in cooperation with the University of Florence, Italy, on a dataset of two hundred consecutive COPD patients who underwent High Resolution Computed Tomography CT scan and spirometry.

The study showed that CT metrics reflecting the severity of emphysema correlated more strongly with ESI (Emphysema Severity Index)  than FEV1 and FEV1/FVC. Furthermore ESI was more independent from functional non- emphysematous gas trapping than standard obstruction indexes.

For validation details and info please read the following paper (Respiratory Research, 2019):

Spirometric assessment of emphysema presence and severity as measured by quantitative CT and CT-based radiomics in COPD


The current version of the ESI-test calculator is based on a novel real-time implementation of the theoretical ESI algorithm. This software was especially designed for clinical practice, pharmacologic trials, medical education and for the evaluation of emphysema whenever spirometry is the only available examination (the application results are still under validation, at the moment is intended for research use only).

The required input data are flow-volume measurements usually available in output reports provided by standard spirometers. (i.e. flow values, FVC). DLco% is not required for this analysis.

Recently, the performances achieved by the current real-time ESI test software have been studied on a large international database of smokers, ex smokers, COPD patients and the results obtained during the experimentation are very interesting.  The analysis reports will be published on important international journals in the next months.


ESI test new version 1.0.3

Updated version of the calculator: ESI – test for the assessment of emphysema New version 1.0.3 is released online. Bug fixes, more data to input for complete reports, faster calculation process. Try it. Request a demo account, visit the contact pages.  

New article published in Respiratory Research about ESI (Emphysema Severity Index) validation and comparison with CT-based metrics : Spirometric assessment of emphysema presence and severity as measured by quantitative CT and CT-based radiomics in COPD. To read or download the paper please follow the link: – Spirometric assessment of emphysema presence and severity as measured …

ESI test Release 1.0.1

The new version of the ESI test for the assessment of emphysema in smokers, ex smokers and patients with COPD, release 1.0.1 is on line ! This ESI test version is active for research use only. For research projects and partnerships please contact us.  

Contact us


For info and details about the new ESI (test for the assessment of emphysema) or research partnership please fill in the following form:




ESI – test: Emphysema Severity Index

Piazza della Indipendenza, XXI