Mucus plugging is associated with COPD mortality

with participants chronic obstructive pulmonary disease (COPD) Patients with medium-to-large airway-obstructing mucus plugs had higher all-cause mortality than those without mucus plugs on chest CT scans, according to a study published in . JAMA. ¹

Airway mucus plugging is prevalent in COPD patients, but the association between airway mucus plugging and mortality in COPD patients was not known.

“Chronic Obstructive Pulmonary Disease (COPD) affects 15.9 million people in the United States and is the fourth leading cause of death. It is characterized by decreased secretion, clearance, and accumulates as plugs in the airways,” the researchers said.

First, the investigators sought to determine whether airway mucus plugging seen on CT scans was associated with increased all-cause mortality.

Next, prospective data of patients diagnosed with COPD in the COPD genetic epidemiology cohort were collected in an observational retrospective analysis. Participants were non-Hispanic blacks or whites between the ages of 45 and 80 who smoked at least 10 pack-years. Participants were enrolled at 21 US centers from November 2007 to April 2011 and were followed up to August 31, 2022.

Mucus plugs that completely occlude airways on chest CT scan are found in medium to large airways (approximately 2–10 mm lumen diameter) and affect 0, 1–2, or more than 3 lung segments. was classified as

The researchers then identified all-cause mortality as the primary outcome, as assessed by proportional hazards regression analysis. Model adjustments were for age, sex, race, ethnicity, body mass index, number of pack years smoked, current smoking status, his forced expiratory volume in the first second of exhalation, and CT measurements of emphysema and airway disease. Done.

Of the 4,483 participants with COPD, 4,363 were included in the primary analysis (median age, 63 years) [IQR, 57-70 years]44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had 0, 1–2, and 3 or more lung segments with mucus plugs, respectively.

Through a median follow-up of 9.5 years, 1769 participants (40.6%) died. Mortality among affected participants was 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) was. Mucus plugs 0, 1-2, and 3 or more lung segments, respectively.

The presence of mucus plugs in 1-2 vs 0 and ≥3 vs 0 lung segments was associated with an adjusted HR of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41) for death. was Each.

Corresponding author Alejandro A. Diaz, M.D., Ph.D., associate scientist in the Department of Respiratory and Critical Care Medicine at Brigham and Women’s Hospital, said: press release“While there is no cure for COPD, which is a chronic disease, our findings suggest that using therapies that disrupt these mucus plugs may improve outcomes for patients with COPD. This is the next best thing.”²

Mucus plugging multiple bronchi can increase the risk of pneumonia and exacerbation of COPD.

“Furthermore, the presence of mucus plugs is associated with ventilation and perfusion mismatch, which may lead to respiratory failure, a common cause of death in COPD,” the researchers continued.

The findings of the study and those of previous studies may generate hypotheses for testing mucus plug-targeted clinical interventions in COPD that may provide therapeutic targets for healthcare providers. Preliminary studies in asthma suggest that biologic therapy reduces mucus plugging on CT and that reduction of mucus plugging is associated with improved lung function.

One of the limitations of this study was that it was observational, so no conclusion could be drawn that mucosal obstruction causes death. Second, only non-Hispanic black and non-Hispanic white participants were enrolled in the COPDGene cohort, so findings may not apply to other racial and ethnic groups not included .

“The fact that these mucus plugs were associated with mortality across different disease stages shows that CT scans can detect aspects of COPD progression, even if patients don’t feel it,” Diaz said. Dr. concluded in a release. .

References

1. Diaz AA, Orellas JL, Gramley S, et al. Airway obstructive mucus plugging and mortality in patients with chronic obstructive pulmonary disease. jam. Published online May 21, 2023. doi: 10.1001/jama.2023.2065

2. Studies linking mucus plugs to COPD mortality may save lives. Eurekarerato! May 21, 2023. Accessed June 5, 2023. https://www.eurekalert.org/news-releases/989777