Mucus Plugs in COPD Are Heterogeneous in Size and Shape and Occur in Relatively Large Airways

Omar N Farooqui; Brett M Elicker; Travis S Henry; Lewis D Hahn; Kimberly G Kallianos; MeiLan K Han; R Graham Barr; Benjamin M Smith; Alejandro P Comellas; Jessica Bon; Nadia Hansel; J Michael Wells; Robert Paine; Igor Barjaktarevic; Joyce D Schroeder; Prescott G Woodruff; Brendan K Huang; John V Fahy

doi:10.1093/ajrccm/aamaf138

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Mucus Plugs in COPD Are Heterogeneous in Size and Shape and Occur in Relatively Large Airways

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Mucus Plugs in COPD Are Heterogeneous in Size and Shape and Occur in Relatively Large Airways

Omar N Farooqui, Brett M Elicker, Travis S Henry, Lewis D Hahn, Kimberly G Kallianos, MeiLan K Han, R Graham Barr, Benjamin M Smith, Alejandro P Comellas, Jessica Bon, …

American journal of respiratory and critical care medicine, Vol.212(2), pp.268-276

02/2026

DOI: 10.1093/ajrccm/aamaf138

PMCID: PMC13051690

PMID: 41738094

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Abstract

BACKGROUND Mucus plugs occur in chronic obstructive pulmonary disease (COPD), but little is known about their size and airway location or whether these mucus plug features change as emphysema worsens. METHODS CT lung scans from 31 participants with COPD from the Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) cohort were analyzed to quantify mucus plug size and airway location and extent of emphysema. Radiologist annotations of mucus plugs were incorporated in an image processing pipeline to generate size and location information. Emphysema was quantified as the percentage of voxels less than −950 Hounsfield units. RESULTS The length distribution of 563 annotated mucus plugs varied from 2 to 50 mm. The distribution was multimodal, and an 11 mm length defined short (“stubby”, ≤11 mm) and long (“stringy”, >11 mm) plug phenotypes with stubby plugs being most common (64%). Mucus plugs localized predominantly to airway generations 6 to 9, and their prevalence was highest in in lower lobes. On a lobar basis, the mucus plug number decreased as emphysema % increased whereas average mucus plug volume tended to increase. CONCLUSION COPD is characterized by mucus plugs of varying size and shape and emphysematous lung regions may be differentially susceptible to formation of these plugs. The location of mucus plugs in segmental and subsegmental airways in COPD makes them amenable to treatment with inhaled medications or bronchoscopy.

COPD

mucus plugs

emphysema

Details

Title: Subtitle: Mucus Plugs in COPD Are Heterogeneous in Size and Shape and Occur in Relatively Large Airways
Creators: Omar N Farooqui - University of California, San Francisco
Brett M Elicker - University of California, San Francisco
Travis S Henry - Duke University
Lewis D Hahn - University of California San Diego
Kimberly G Kallianos - University of California, San Francisco
MeiLan K Han - University of Michigan
R Graham Barr - Columbia University Irving Medical Center
Benjamin M Smith - Columbia University Irving Medical Center
Alejandro P Comellas - University of Iowa
Jessica Bon - Wake Forest University
Nadia Hansel - Johns Hopkins Medicine
J Michael Wells - University of Alabama at Birmingham
Robert Paine - University of Utah
Igor Barjaktarevic - University of California, Los Angeles
Joyce D Schroeder
Prescott G Woodruff - University of California, San Francisco
Brendan K Huang
John V Fahy - University of California, San Francisco
Resource Type: Journal article
Publication Details: American journal of respiratory and critical care medicine, Vol.212(2), pp.268-276
DOI: 10.1093/ajrccm/aamaf138
PMID: 41738094
PMCID: PMC13051690
NLM abbreviation: Am J Respir Crit Care Med
ISSN: 1073-449X
eISSN: 1535-4970
Publisher: Oxford University Press
Grant note: COPD Foundation Amgen NHLBI: HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C, 75N92024D00012 Forest Research Institute Boehringer-Ingelheim Pharmaceuticals AstraZeneca NIH
SPIROMICS was supported by contracts from the NIH/NHLBI (HHSN268200900013C, HHSN268200900014C, HHSN268200900015C, HHSN268200900016C, HHSN268200900017C, HHSN268200900018C, HHSN268200900019C, HHSN268200900020C, and 75N92024D00012); grants from the NIH/NHLBI (U01HL137880, U24HL141762, R01HL182622, R01HL144718, and R01HL093081); and supplemented by contributions made through the Foundation for the NIH and the COPD Foundation from Amgen, AstraZeneca/MedImmune, Bayer, Bellerophon Therapeutics, Boehringer-Ingelheim Pharmaceuticals, Bristol Myers Squibb, Chiesi Farmaceutici S.p.A., Forest Research Institute, Genentech, GlaxoSmithKline, Grifols Therapeutics, Ikaria, MGC Diagnostics, Novartis Pharmaceuticals, Nycomed GmbH, Polarean, ProterixBio, Regeneron Pharmaceuticals, Sanofi, Sunovion, Takeda Pharmaceutical Company, Theravance Biopharma, Verona, and Mylan/Viatris.
Language: English
Electronic publication date: 01/23/2026
Date published: 02/2026
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9985132202102771

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