Journal article
Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
American journal of respiratory and critical care medicine, Vol.203(8), pp.957-968
04/15/2021
DOI: 10.1164/rccm.202006-2248OC
PMCID: PMC8048745
PMID: 33180550
Abstract
Rationale:
The relative roles of mucus plugs and emphysema in mechanisms of airflow limitation and hypoxemia in smokers with chronic obstructive pulmonary disease (COPD) are uncertain.
Objectives:
To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.
Methods:
We analyzed computed tomographic (CT) lung images and lung function in participants in the Subpopulations and Intermediate Outcome Measures in COPD Study. Radiologists scored mucus plugs on CT lung images, and imaging software automatically quantified emphysema percentage. Unadjusted and adjusted relationships between mucus plug score, emphysema percentage, and lung function were determined using regression.
Measurements and Main Results:
Among 400 smokers, 229 (57%) had mucus plugs and 207 (52%) had emphysema, and subgroups could be identified with mucus-dominant and emphysema-dominant disease. Only 33% of smokers with high mucus plug scores had mucus symptoms. Mucus plug score and emphysema percentage were independently associated with lower values for FEV
1
and peripheral oxygen saturation (
P
< 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (
P
< 0.001). Compared with smokers with low mucus plug scores, those with high scores had worse COPD Assessment Test scores (17.4 ± 7.7 vs. 14.4 ± 13.3), more frequent annual exacerbations (0.75 ± 1.1 vs. 0.43 ± 0.85), and shorter 6-minute-walk distance (329 ± 115 vs. 392 ± 117 m) (
P
< 0.001).
Conclusions:
Symptomatically silent mucus plugs are highly prevalent in smokers and independently associate with lung function outcomes. These data provide rationale for targeting patients with mucus-high/emphysema-low COPD in clinical trials of mucoactive treatments.
Clinical trial registered with
www.clinicaltrials.gov
(NCT01969344).
Details
- Title: Subtitle
- Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
- Creators
- Eleanor M. Dunican - St. Vincent's University HospitalBrett M. Elicker - Department of Radiology and Biomedical Imaging.Travis Henry - Department of Radiology and Biomedical Imaging.David S. Gierada - Washington University in St. Louis School of MedicineMark L. Schiebler - University of Wisconsin–MadisonWayne Anderson - Division of Pulmonary and Critical Care Medicine, Department of Medicine.Igor Barjaktarevic - University of California, Los AngelesR. Graham Barr - Columbia UniversityEugene R. Bleecker - University of ArizonaRichard C. Boucher - Lung InstituteRussell Bowler - National Jewish HealthStephanie A. Christenson - University of California, San FranciscoAlejandro Comellas - Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine.Christopher B. Cooper - University of California, Los AngelesDavid Couper - University of North Carolina at Chapel HillGerard J. Criner - Temple UniversityMark Dransfield - University of Alabama at BirminghamClaire M. Doerschuk - Lung InstituteM. Bradley Drummond - Division of Pulmonary and Critical Care Medicine, Department of MedicineNadia N. Hansel - Johns Hopkins UniversityMeiLan K. Han - University of MichiganAnnette T. Hastie - Wake Forest UniversityEric A. Hoffman - University of IowaJerry A. Krishnan - University of Illinois ChicagoStephen C. Lazarus - University of California, San FranciscoFernando J. Martinez - Weill Cornell MedicineCharles E. McCulloch - University of California, San FranciscoWanda K. O’Neal - Marsico Lung Institute/UNC Cystic Fibrosis Center, andVictor E. Ortega - Wake Forest UniversityRobert Paine - University of UtahStephen Peters - Wake Forest UniversityJoyce D. Schroeder - University of UtahPrescott G. Woodruff - University of California, San FranciscoJohn V. Fahy - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.203(8), pp.957-968
- DOI
- 10.1164/rccm.202006-2248OC
- PMID
- 33180550
- PMCID
- PMC8048745
- NLM abbreviation
- Am J Respir Crit Care Med
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Publisher
- American Thoracic Society
- Language
- English
- Date published
- 04/15/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9984318698502771
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