Hi thanks for contacting HCM... Noted you have emphysema and fatty liver.... Here your smoking habit is contributing in both these condition... As smoking can release elastase and that can damage alveoli.... Alpha 1 antitrypsin deficiency also has to be rule out as both liver and lung affected... Here first try to avoid smoking for improvement Because of emphysema here you have chest tightness and pain... If dyspnea is associated bronchodilator might needed.... For fatty liver low fat diet taken. Refined food avoided with using less oil in cooking. Regular exercise done.... Avoid exposure to environmental pollution to less..... Regular follow up needed. For small nodule that is present if increasing in size then USG guided FNAC done for further work up.... Take care... Dr.Parth