Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
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. To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients wit...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2021-04, Vol.203 (8), p.957-968 |
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| creator | Dunican, Eleanor M Elicker, Brett M Henry, Travis Gierada, David S Schiebler, Mark L Anderson, Wayne Barjaktarevic, Igor Barr, R Graham Bleecker, Eugene R Boucher, Richard C Bowler, Russell Christenson, Stephanie A Comellas, Alejandro Cooper, Christopher B Couper, David Criner, Gerard J Dransfield, Mark Doerschuk, Claire M Drummond, M Bradley Hansel, Nadia N Han, MeiLan K Hastie, Annette T Hoffman, Eric A Krishnan, Jerry A Lazarus, Stephen C Martinez, Fernando J McCulloch, Charles E O'Neal, Wanda K Ortega, Victor E Paine, 3rd, Robert Peters, Stephen Schroeder, Joyce D Woodruff, Prescott G Fahy, John V |
| description | 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.
To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.
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.
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
and peripheral oxygen saturation (
|
| doi_str_mv | 10.1164/rccm.202006-2248OC |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8048745</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2515757665</sourcerecordid><originalsourceid>FETCH-LOGICAL-c594t-23b3b58f1ff2cba5a3c2b89d954d92dfd5b91409b42fd6b3617470288eb671393</originalsourceid><addsrcrecordid>eNpdkUlvFDEQhS0EIgv8AQ7IEhcuHbwvF6RolAUpaCIBEjdju-0Zh-72YHcnmX9PTyZEwKlKVe89VekD4A1GJxgL9qF4358QRBASDSFMLRfPwCHmlDdMS_R87pGkDWP6-wE4qvUGIUwURi_BAaVYIc7RIfjxefJThdfdtKrQDi086zfrbQ29hWmA4zrAazuu826WcpdXW5gjPE0ldvkOLl0dy-THlIcH7-V2k-9Dnx68X_r8M5T6CryItqvh9WM9Bt_Oz74uLpur5cWnxelV47lmY0Ooo46riGMk3lluqSdO6VZz1mrSxpY7jRnSjpHYCkcFlkwiolRwQmKq6TH4uM_dTK4PrQ_DWGxnNiX1tmxNtsn8uxnS2qzyrVGIKcn4HPD-MaDkX1Ooo-lT9aHr7BDyVA1hAkmhkWSz9N1_0ps8lWF-zxCOueRSiF0g2at8ybWWEJ-OwcjsAJodQLMHaPYAZ9Pbv994svwhRn8DV7uY7w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2515757665</pqid></control><display><type>article</type><title>Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers</title><source>MEDLINE</source><source>American Thoracic Society (ATS) Journals Online</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Dunican, Eleanor M ; Elicker, Brett M ; Henry, Travis ; Gierada, David S ; Schiebler, Mark L ; Anderson, Wayne ; Barjaktarevic, Igor ; Barr, R Graham ; Bleecker, Eugene R ; Boucher, Richard C ; Bowler, Russell ; Christenson, Stephanie A ; Comellas, Alejandro ; Cooper, Christopher B ; Couper, David ; Criner, Gerard J ; Dransfield, Mark ; Doerschuk, Claire M ; Drummond, M Bradley ; Hansel, Nadia N ; Han, MeiLan K ; Hastie, Annette T ; Hoffman, Eric A ; Krishnan, Jerry A ; Lazarus, Stephen C ; Martinez, Fernando J ; McCulloch, Charles E ; O'Neal, Wanda K ; Ortega, Victor E ; Paine, 3rd, Robert ; Peters, Stephen ; Schroeder, Joyce D ; Woodruff, Prescott G ; Fahy, John V</creator><creatorcontrib>Dunican, Eleanor M ; Elicker, Brett M ; Henry, Travis ; Gierada, David S ; Schiebler, Mark L ; Anderson, Wayne ; Barjaktarevic, Igor ; Barr, R Graham ; Bleecker, Eugene R ; Boucher, Richard C ; Bowler, Russell ; Christenson, Stephanie A ; Comellas, Alejandro ; Cooper, Christopher B ; Couper, David ; Criner, Gerard J ; Dransfield, Mark ; Doerschuk, Claire M ; Drummond, M Bradley ; Hansel, Nadia N ; Han, MeiLan K ; Hastie, Annette T ; Hoffman, Eric A ; Krishnan, Jerry A ; Lazarus, Stephen C ; Martinez, Fernando J ; McCulloch, Charles E ; O'Neal, Wanda K ; Ortega, Victor E ; Paine, 3rd, Robert ; Peters, Stephen ; Schroeder, Joyce D ; Woodruff, Prescott G ; Fahy, John V</creatorcontrib><description>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.
To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.
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.
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
and peripheral oxygen saturation (
< 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (
< 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) (
< 0.001).
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).</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.202006-2248OC</identifier><identifier>PMID: 33180550</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Aged ; Chronic obstructive pulmonary disease ; Clinical trials ; Emphysema ; Female ; Forced Expiratory Volume ; Healthy Volunteers ; Humans ; Hypoxemia ; Hypoxia - chemically induced ; Hypoxia - physiopathology ; Male ; Middle Aged ; Mucus ; Original ; Pathophysiology ; Pulmonary Disease, Chronic Obstructive - chemically induced ; Pulmonary Disease, Chronic Obstructive - physiopathology ; Pulmonary Emphysema - chemically induced ; Pulmonary Emphysema - physiopathology ; Respiratory Function Tests ; Smokers ; Smoking ; Smoking - adverse effects ; Tomography ; Vital Capacity</subject><ispartof>American journal of respiratory and critical care medicine, 2021-04, Vol.203 (8), p.957-968</ispartof><rights>Copyright American Thoracic Society Apr 15, 2021</rights><rights>Copyright © 2021 by the American Thoracic Society 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-23b3b58f1ff2cba5a3c2b89d954d92dfd5b91409b42fd6b3617470288eb671393</citedby><cites>FETCH-LOGICAL-c594t-23b3b58f1ff2cba5a3c2b89d954d92dfd5b91409b42fd6b3617470288eb671393</cites><orcidid>0000-0003-1521-7520 ; 0000-0002-6968-4610 ; 0000-0001-5525-4778 ; 0000-0001-6607-7797 ; 0000-0003-4014-5100</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33180550$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dunican, Eleanor M</creatorcontrib><creatorcontrib>Elicker, Brett M</creatorcontrib><creatorcontrib>Henry, Travis</creatorcontrib><creatorcontrib>Gierada, David S</creatorcontrib><creatorcontrib>Schiebler, Mark L</creatorcontrib><creatorcontrib>Anderson, Wayne</creatorcontrib><creatorcontrib>Barjaktarevic, Igor</creatorcontrib><creatorcontrib>Barr, R Graham</creatorcontrib><creatorcontrib>Bleecker, Eugene R</creatorcontrib><creatorcontrib>Boucher, Richard C</creatorcontrib><creatorcontrib>Bowler, Russell</creatorcontrib><creatorcontrib>Christenson, Stephanie A</creatorcontrib><creatorcontrib>Comellas, Alejandro</creatorcontrib><creatorcontrib>Cooper, Christopher B</creatorcontrib><creatorcontrib>Couper, David</creatorcontrib><creatorcontrib>Criner, Gerard J</creatorcontrib><creatorcontrib>Dransfield, Mark</creatorcontrib><creatorcontrib>Doerschuk, Claire M</creatorcontrib><creatorcontrib>Drummond, M Bradley</creatorcontrib><creatorcontrib>Hansel, Nadia N</creatorcontrib><creatorcontrib>Han, MeiLan K</creatorcontrib><creatorcontrib>Hastie, Annette T</creatorcontrib><creatorcontrib>Hoffman, Eric A</creatorcontrib><creatorcontrib>Krishnan, Jerry A</creatorcontrib><creatorcontrib>Lazarus, Stephen C</creatorcontrib><creatorcontrib>Martinez, Fernando J</creatorcontrib><creatorcontrib>McCulloch, Charles E</creatorcontrib><creatorcontrib>O'Neal, Wanda K</creatorcontrib><creatorcontrib>Ortega, Victor E</creatorcontrib><creatorcontrib>Paine, 3rd, Robert</creatorcontrib><creatorcontrib>Peters, Stephen</creatorcontrib><creatorcontrib>Schroeder, Joyce D</creatorcontrib><creatorcontrib>Woodruff, Prescott G</creatorcontrib><creatorcontrib>Fahy, John V</creatorcontrib><title>Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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.
To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.
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.
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
and peripheral oxygen saturation (
< 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (
< 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) (
< 0.001).
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).</description><subject>Aged</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Clinical trials</subject><subject>Emphysema</subject><subject>Female</subject><subject>Forced Expiratory Volume</subject><subject>Healthy Volunteers</subject><subject>Humans</subject><subject>Hypoxemia</subject><subject>Hypoxia - chemically induced</subject><subject>Hypoxia - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mucus</subject><subject>Original</subject><subject>Pathophysiology</subject><subject>Pulmonary Disease, Chronic Obstructive - chemically induced</subject><subject>Pulmonary Disease, Chronic Obstructive - physiopathology</subject><subject>Pulmonary Emphysema - chemically induced</subject><subject>Pulmonary Emphysema - physiopathology</subject><subject>Respiratory Function Tests</subject><subject>Smokers</subject><subject>Smoking</subject><subject>Smoking - adverse effects</subject><subject>Tomography</subject><subject>Vital Capacity</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUlvFDEQhS0EIgv8AQ7IEhcuHbwvF6RolAUpaCIBEjdju-0Zh-72YHcnmX9PTyZEwKlKVe89VekD4A1GJxgL9qF4358QRBASDSFMLRfPwCHmlDdMS_R87pGkDWP6-wE4qvUGIUwURi_BAaVYIc7RIfjxefJThdfdtKrQDi086zfrbQ29hWmA4zrAazuu826WcpdXW5gjPE0ldvkOLl0dy-THlIcH7-V2k-9Dnx68X_r8M5T6CryItqvh9WM9Bt_Oz74uLpur5cWnxelV47lmY0Ooo46riGMk3lluqSdO6VZz1mrSxpY7jRnSjpHYCkcFlkwiolRwQmKq6TH4uM_dTK4PrQ_DWGxnNiX1tmxNtsn8uxnS2qzyrVGIKcn4HPD-MaDkX1Ooo-lT9aHr7BDyVA1hAkmhkWSz9N1_0ps8lWF-zxCOueRSiF0g2at8ybWWEJ-OwcjsAJodQLMHaPYAZ9Pbv994svwhRn8DV7uY7w</recordid><startdate>20210415</startdate><enddate>20210415</enddate><creator>Dunican, Eleanor M</creator><creator>Elicker, Brett M</creator><creator>Henry, Travis</creator><creator>Gierada, David S</creator><creator>Schiebler, Mark L</creator><creator>Anderson, Wayne</creator><creator>Barjaktarevic, Igor</creator><creator>Barr, R Graham</creator><creator>Bleecker, Eugene R</creator><creator>Boucher, Richard C</creator><creator>Bowler, Russell</creator><creator>Christenson, Stephanie A</creator><creator>Comellas, Alejandro</creator><creator>Cooper, Christopher B</creator><creator>Couper, David</creator><creator>Criner, Gerard J</creator><creator>Dransfield, Mark</creator><creator>Doerschuk, Claire M</creator><creator>Drummond, M Bradley</creator><creator>Hansel, Nadia N</creator><creator>Han, MeiLan K</creator><creator>Hastie, Annette T</creator><creator>Hoffman, Eric A</creator><creator>Krishnan, Jerry A</creator><creator>Lazarus, Stephen C</creator><creator>Martinez, Fernando J</creator><creator>McCulloch, Charles E</creator><creator>O'Neal, Wanda K</creator><creator>Ortega, Victor E</creator><creator>Paine, 3rd, Robert</creator><creator>Peters, Stephen</creator><creator>Schroeder, Joyce D</creator><creator>Woodruff, Prescott G</creator><creator>Fahy, John V</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1521-7520</orcidid><orcidid>https://orcid.org/0000-0002-6968-4610</orcidid><orcidid>https://orcid.org/0000-0001-5525-4778</orcidid><orcidid>https://orcid.org/0000-0001-6607-7797</orcidid><orcidid>https://orcid.org/0000-0003-4014-5100</orcidid></search><sort><creationdate>20210415</creationdate><title>Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers</title><author>Dunican, Eleanor M ; Elicker, Brett M ; Henry, Travis ; Gierada, David S ; Schiebler, Mark L ; Anderson, Wayne ; Barjaktarevic, Igor ; Barr, R Graham ; Bleecker, Eugene R ; Boucher, Richard C ; Bowler, Russell ; Christenson, Stephanie A ; Comellas, Alejandro ; Cooper, Christopher B ; Couper, David ; Criner, Gerard J ; Dransfield, Mark ; Doerschuk, Claire M ; Drummond, M Bradley ; Hansel, Nadia N ; Han, MeiLan K ; Hastie, Annette T ; Hoffman, Eric A ; Krishnan, Jerry A ; Lazarus, Stephen C ; Martinez, Fernando J ; McCulloch, Charles E ; O'Neal, Wanda K ; Ortega, Victor E ; Paine, 3rd, Robert ; Peters, Stephen ; Schroeder, Joyce D ; Woodruff, Prescott G ; Fahy, John V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-23b3b58f1ff2cba5a3c2b89d954d92dfd5b91409b42fd6b3617470288eb671393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Clinical trials</topic><topic>Emphysema</topic><topic>Female</topic><topic>Forced Expiratory Volume</topic><topic>Healthy Volunteers</topic><topic>Humans</topic><topic>Hypoxemia</topic><topic>Hypoxia - chemically induced</topic><topic>Hypoxia - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mucus</topic><topic>Original</topic><topic>Pathophysiology</topic><topic>Pulmonary Disease, Chronic Obstructive - chemically induced</topic><topic>Pulmonary Disease, Chronic Obstructive - physiopathology</topic><topic>Pulmonary Emphysema - chemically induced</topic><topic>Pulmonary Emphysema - physiopathology</topic><topic>Respiratory Function Tests</topic><topic>Smokers</topic><topic>Smoking</topic><topic>Smoking - adverse effects</topic><topic>Tomography</topic><topic>Vital Capacity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dunican, Eleanor M</creatorcontrib><creatorcontrib>Elicker, Brett M</creatorcontrib><creatorcontrib>Henry, Travis</creatorcontrib><creatorcontrib>Gierada, David S</creatorcontrib><creatorcontrib>Schiebler, Mark L</creatorcontrib><creatorcontrib>Anderson, Wayne</creatorcontrib><creatorcontrib>Barjaktarevic, Igor</creatorcontrib><creatorcontrib>Barr, R Graham</creatorcontrib><creatorcontrib>Bleecker, Eugene R</creatorcontrib><creatorcontrib>Boucher, Richard C</creatorcontrib><creatorcontrib>Bowler, Russell</creatorcontrib><creatorcontrib>Christenson, Stephanie A</creatorcontrib><creatorcontrib>Comellas, Alejandro</creatorcontrib><creatorcontrib>Cooper, Christopher B</creatorcontrib><creatorcontrib>Couper, David</creatorcontrib><creatorcontrib>Criner, Gerard J</creatorcontrib><creatorcontrib>Dransfield, Mark</creatorcontrib><creatorcontrib>Doerschuk, Claire M</creatorcontrib><creatorcontrib>Drummond, M Bradley</creatorcontrib><creatorcontrib>Hansel, Nadia N</creatorcontrib><creatorcontrib>Han, MeiLan K</creatorcontrib><creatorcontrib>Hastie, Annette T</creatorcontrib><creatorcontrib>Hoffman, Eric A</creatorcontrib><creatorcontrib>Krishnan, Jerry A</creatorcontrib><creatorcontrib>Lazarus, Stephen C</creatorcontrib><creatorcontrib>Martinez, Fernando J</creatorcontrib><creatorcontrib>McCulloch, Charles E</creatorcontrib><creatorcontrib>O'Neal, Wanda K</creatorcontrib><creatorcontrib>Ortega, Victor E</creatorcontrib><creatorcontrib>Paine, 3rd, Robert</creatorcontrib><creatorcontrib>Peters, Stephen</creatorcontrib><creatorcontrib>Schroeder, Joyce D</creatorcontrib><creatorcontrib>Woodruff, Prescott G</creatorcontrib><creatorcontrib>Fahy, John V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dunican, Eleanor M</au><au>Elicker, Brett M</au><au>Henry, Travis</au><au>Gierada, David S</au><au>Schiebler, Mark L</au><au>Anderson, Wayne</au><au>Barjaktarevic, Igor</au><au>Barr, R Graham</au><au>Bleecker, Eugene R</au><au>Boucher, Richard C</au><au>Bowler, Russell</au><au>Christenson, Stephanie A</au><au>Comellas, Alejandro</au><au>Cooper, Christopher B</au><au>Couper, David</au><au>Criner, Gerard J</au><au>Dransfield, Mark</au><au>Doerschuk, Claire M</au><au>Drummond, M Bradley</au><au>Hansel, Nadia N</au><au>Han, MeiLan K</au><au>Hastie, Annette T</au><au>Hoffman, Eric A</au><au>Krishnan, Jerry A</au><au>Lazarus, Stephen C</au><au>Martinez, Fernando J</au><au>McCulloch, Charles E</au><au>O'Neal, Wanda K</au><au>Ortega, Victor E</au><au>Paine, 3rd, Robert</au><au>Peters, Stephen</au><au>Schroeder, Joyce D</au><au>Woodruff, Prescott G</au><au>Fahy, John V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2021-04-15</date><risdate>2021</risdate><volume>203</volume><issue>8</issue><spage>957</spage><epage>968</epage><pages>957-968</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>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.
To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.
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.
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
and peripheral oxygen saturation (
< 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (
< 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) (
< 0.001).
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).</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>33180550</pmid><doi>10.1164/rccm.202006-2248OC</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-1521-7520</orcidid><orcidid>https://orcid.org/0000-0002-6968-4610</orcidid><orcidid>https://orcid.org/0000-0001-5525-4778</orcidid><orcidid>https://orcid.org/0000-0001-6607-7797</orcidid><orcidid>https://orcid.org/0000-0003-4014-5100</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2021-04, Vol.203 (8), p.957-968 |
| issn | 1073-449X 1535-4970 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8048745 |
| source | MEDLINE; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Chronic obstructive pulmonary disease Clinical trials Emphysema Female Forced Expiratory Volume Healthy Volunteers Humans Hypoxemia Hypoxia - chemically induced Hypoxia - physiopathology Male Middle Aged Mucus Original Pathophysiology Pulmonary Disease, Chronic Obstructive - chemically induced Pulmonary Disease, Chronic Obstructive - physiopathology Pulmonary Emphysema - chemically induced Pulmonary Emphysema - physiopathology Respiratory Function Tests Smokers Smoking Smoking - adverse effects Tomography Vital Capacity |
| title | Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers |
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