ESI, Emphysema Severity Index calculation

Emphysema APP

ESI, emphysema assessment

ESI, Emphysema Severity Index for the assessment of emphysema in smokers, ex smokers and patients with COPD

The ESI index is a quantitative score (0-10) reflecting the severity of emphysema.

The ESI methodology was implemented to provide a simple and effective tool for the assessment of emphysema severity in smokers, ex-smokers patients with COPD.

The server-side (real time) software – Emphysema App – developed for ESI calculation is now validated. The web-based application available here at was used to calculate the ESI (Emphysema Severity Index) in a population of 5930 subjects (smokers, ex-smokers, patients with COPD).

The ESI values were compared with the CT-based metrics obtained by advanced software (CT images analysis).

The results are now published in Respiratory Research:

Validation of a method to assess emphysema severity by spirometry in the COPDGene study


ESI is now available for:

  • Emphysema assessment by spirometry in smokers, ex-smokers, patients with COPD
  • Application on prospective wide-scale clinical trials
  • Post-hoc analyses of previous randomized pharmacologic clinical trials to evaluate the effects of emphysema severity on the outcome
  • Scientific partnerships and publications
  • Integration on portable devices and spirometers
  • Integration of ESI in clinical records software
  • Batch analysis of large datasets

The analysis is based uniquely on data derived by standard spirometry without any standardization or normalization (i.e. % pred. or LLN, z-scores, etc…, DLco is not requested.)

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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 digital platform

The ESI digital platform

emphysema . app is the access point to the ESI digital platform. The ESI index 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 calculations.

Automated analysis

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

Simple use

To perform the ESI calculation  it’s 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 Automated Reports

ESI report example

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

Please contact us to calculate ESI or to integrate ESI in your projects:




CT-based validation of the ESI index 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 Section of Respiratory Medicine directed by Prof. Massimo Pistolesi, Department of Experimental and Clinical Medicine, University of Florence, 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 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 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.

For info and details about validation of the ESI software for the assessment of emphysema severity in a large population of smokers, ex-smokers and subjects with COPD please read the following paper (Respiratory Research, 2020):

Validation of a method to assess emphysema severity by spirometry in the COPDGene study


The software Emphysema App is now officially SIAE registered.

The software for the calculation of the ESI is now officially registered. All the published computer programs that respect the originality and creativity requisites can be registered to the SIAE Public Register for Software with unique ID CODE so they can be identified as official intellectual properties. The software is officially protected. All …

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For info and details about ESI (index for the assessment of emphysema), ESI calculation, research partnerships, clinical trials, batch analysis of large datasets, please contact us:




ESI: Emphysema Severity Index – A.I., Data Mining, Signal Processing, Statistics, I.T. Consulting

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