Mucus plugs and emphysema in the pathophysiology of airflow obstruction and hypoxemia in smokers

Eleanor M. Dunican, Brett M. Elicker, Travis Henry, David S. Gierada, Mark L. Schiebler, Wayne Anderson, Igor Barjaktarevic, R. Graham Barr, Eugene R. Bleecker, Richard C. Boucher, Russell Bowler, Stephanie A. Christenson, Alejandro Comellas, Christopher B. Cooper, David Couper, Gerard J. Criner, Mark Dransfield, Claire M. Doerschuk, M. Bradley Drummond, Nadia N. HanselMei Lan K. Han, Annette T. Hastie, Eric A. Hoffman, Jerry A. Krishnan, Stephen C. Lazarus, Fernando J. Martinez, Charles E. McCulloch, Wanda K. O'Neal, Victor E. Ortega, Robert Paine, Stephen Peters, Joyce D. Schroeder, Prescott G. Woodruff, John V. Fahy

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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 FEV1 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 6 7.7 vs. 14.4 6 13.3), more frequent annual exacerbations (0.75 6 1.1 vs. 0.43 6 0.85), and shorter 6-minute-walk distance (329 6 115 vs. 392 6 117 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.

Original languageEnglish
Pages (from-to)957-968
Number of pages12
JournalAmerican journal of respiratory and critical care medicine
Volume203
Issue number8
DOIs
StatePublished - 2021

Keywords

  • COPD
  • Computed tomography
  • Emphysema
  • FEV
  • Mucus plugs

Fingerprint

Dive into the research topics of 'Mucus plugs and emphysema in the pathophysiology of airflow obstruction and hypoxemia in smokers'. Together they form a unique fingerprint.

Cite this