Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers.
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 ± 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).
['Dunican|Eleanor M|EM|0000-0003-4014-5100', 'Elicker|Brett M|BM|', 'Henry|Travis|T|', 'Gierada|David S|DS|', 'Schiebler|Mark L|ML|', 'Anderson|Wayne|W|', 'Barjaktarevic|Igor|I|', 'Barr|R Graham|RG|', 'Bleecker|Eugene R|ER|', 'Boucher|Richard C|RC|', 'Bowler|Russell|R|', 'Christenson|Stephanie A|SA|', 'Comellas|Alejandro|A|0000-0003-1521-7520', 'Cooper|Christopher B|CB|', 'Couper|David|D|', 'Criner|Gerard J|GJ|', 'Dransfield|Mark|M|', 'Doerschuk|Claire M|CM|', 'Drummond|M Bradley|MB|0000-0002-6968-4610', 'Hansel|Nadia N|NN|', 'Han|MeiLan K|MK|', 'Hastie|Annette T|AT|0000-0001-6607-7797', 'Hoffman|Eric A|EA|', 'Krishnan|Jerry A|JA|0000-0001-5525-4778', 'Lazarus|Stephen C|SC|', 'Martinez|Fernando J|FJ|', 'McCulloch|Charles E|CE|', "O'Neal|Wanda K|WK|", 'Ortega|Victor E|VE|', 'Paine|Robert|R|', 'Peters|Stephen|S|', 'Schroeder|Joyce D|JD|', 'Woodruff|Prescott G|PG|', 'Fahy|John V|JV|']
D000368:Aged D005260:Female D005541:Forced Expiratory Volume D064368:Healthy Volunteers D006801:Humans D000860:Hypoxia D008297:Male D008875:Middle Aged D009093:Mucus D029424:Pulmonary Disease, Chronic Obstructive D011656:Pulmonary Emphysema D012129:Respiratory Function Tests D000074285:Smokers D012907:Smoking D014797:Vital Capacity
mucus plugs emphysema COPD FEV1 computed tomography