Journal article
Mucus Plugs in COPD Are Heterogeneous in Size and Shape and Occur in Relatively Large Airways
American journal of respiratory and critical care medicine
01/23/2026
DOI: 10.1093/ajrccm/aamaf138
PMCID: PMC13051690
PMID: 41738094
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.
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 FranciscoBrett M Elicker - University of California, San FranciscoTravis S Henry - Duke UniversityLewis D Hahn - University of California San DiegoKimberly G Kallianos - University of California, San FranciscoMeiLan K Han - University of MichiganR Graham Barr - Columbia University Irving Medical CenterBenjamin M Smith - Columbia University Irving Medical CenterAlejandro P Comellas - University of IowaJessica Bon - Wake Forest UniversityNadia Hansel - Johns Hopkins MedicineJ Michael Wells - University of Alabama at BirminghamRobert Paine - University of UtahIgor Barjaktarevic - University of California, Los AngelesJoyce D SchroederPrescott G Woodruff - University of California, San FranciscoBrendan K HuangJohn V Fahy - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine
- DOI
- 10.1093/ajrccm/aamaf138
- PMID
- 41738094
- PMCID
- PMC13051690
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Publisher
- Oxford University Press
- Language
- English
- Electronic publication date
- 01/23/2026
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
- Record Identifier
- 9985132202102771
Metrics
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