In the respiratory medicine clinic, we often encounter some patients who smoke, and whenever we want to give them some tests, these “smoker” friends will tell the doctor: “I just had a chest physical examination, and there is no problem with the lungs”. When asked carefully, the physical examination is actually just a chest X-ray fluoroscopy, that is to say, the “fluoroscopy” did not find the problem. In the last year, I have met several smokers who had lung cancer, and they had a fluoroscopy within six months before they were diagnosed with lung cancer, and no problems were found. So, how do you get a lung check-up for smokers? For those who are smoking, or who have smoked, a lung physical exam should include three major parts. The first part is imaging. In layman’s terms, this is an x-ray. There are three main types of X-rays that we are often exposed to: fluoroscopy, radiographs, and CT. A simple understanding of the relationship between these three is similar to “puppet show, black and white photos, television”. Different machines, of course, show different results. Ordinary X-ray fluoroscopy, due to its low clarity, has gradually “faded out of the line”, and certainly not suitable for “smokers” friends to do medical examinations. Although the digital era, the clarity of the X-ray film greatly improved, but its basic imaging principle has not changed, a three-dimensional chest imaging on a film, will inevitably lead to many images overlapping together, it is difficult to find the lesions hiding in the corners. In contrast, CT examination is to accurately reproduce the image of a cross-section of the chest at intervals of 5 mm or even 0.5 mm, and after computer image reconstruction technology, the lesions in the chest can be observed from a three-dimensional perspective. On the one hand, it can find microscopic lesions at the millimeter level, and it can also find hidden lesions, which is especially suitable for the detection of early lung cancer and other diseases. For “smokers”, especially those who are over 55 years old, have a smoking history of more than 30 years, and are still smoking or have quit smoking for less than 15 years, they belong to the high-risk group of lung cancer, so it is certainly recommended to choose CT for examination. Some friends may ask, won’t there be radiation for CT? Generally, for lung examination, you can choose low-dose lung CT examination, which has low radiation. However, it is possible to detect early lung cancer through this test, and also diseases caused by smoking such as interstitial lung fibrosis. The second part is the pulmonary function test. Pulmonary function is to check the ventilation and air exchange function of the lungs. In layman’s terms: the imaging test mentioned earlier is to see how our lungs look like, while the pulmonary function test is to check how strong our lungs are. Pulmonary function testing is done with a spirometer. When it comes to spirometer, some of you have the impression that it is a big floating guy that is very tiring to do, but that was actually decades ago. Nowadays, pulmonary function machines are equipped with sophisticated flow sensors, which make it easy and fast to complete the examination, and are standard in almost all secondary and tertiary hospitals. For friends who smoke, long-term smoking can lead to impairment of lung function until the development of chronic obstructive pulmonary disease. However, in the early stages of the disease, although there are problems with lung function, there may not be any symptoms such as shortness of breath, so having a lung function test can detect lung disease caused by smoking early and treat it early. The third part is the blood test. This is a part of the test that is called “serum tumor markers”. These include carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 (CYFRA211), and other tests for lung tumors. These tests can detect some of the “clues” of early lung tumors. They are certainly a “must have” in the medical checkup package for smokers. The above is a brief discussion of the lung checkups that should be done for smokers. Of course, in addition to regular medical checkups, quitting smoking is the fundamental way. Many hospitals have smoking cessation clinics, which help people quit smoking through special smoking cessation drugs and other means.