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Tytuł:
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Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers.
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Autorzy:
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Dunican EM; Education and Research Centre, St. Vincent's University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.
Elicker BM; Department of Radiology and Biomedical Imaging.
Henry T; Department of Radiology and Biomedical Imaging.
Gierada DS; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Schiebler ML; Department of Medical Physics and.; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Anderson W; Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Barjaktarevic I; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California.
Barr RG; Division of General Medicine, Department of Medicine, Columbia University, New York City, New York.
Bleecker ER; Division of Genetics, Genomics, and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona.
Boucher RC; Marsico Lung Institute/UNC Cystic Fibrosis Center, and.
Bowler R; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado.
Christenson SA; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cardiovascular Research Institute, and.
Comellas A; Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine.
Cooper CB; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California.
Couper D; Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Criner GJ; Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania.
Dransfield M; Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Doerschuk CM; Marsico Lung Institute/UNC Cystic Fibrosis Center, and.
Drummond MB; Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Hansel NN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Han MK; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan at Ann Arbor, Ann Arbor, Michigan.
Hastie AT; Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.
Hoffman EA; Department of Radiology.; Department of Medicine, and.; Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa.
Krishnan JA; Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Lazarus SC; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cardiovascular Research Institute, and.
Martinez FJ; Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine and New York-Presbyterian Weill Cornell Medical Center, New York, New York.
McCulloch CE; Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California.
O'Neal WK; Marsico Lung Institute/UNC Cystic Fibrosis Center, and.
Ortega VE; Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.
Paine R 3rd; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah Hospitals and Clinics, Salt Lake City, Utah.; Department of Veterans Affairs Medical Center, Salt Lake City, Utah; and.
Peters S; Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.
Schroeder JD; Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah.
Woodruff PG; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cardiovascular Research Institute, and.
Fahy JV; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cardiovascular Research Institute, and.
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Źródło:
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American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2021 Apr 15; Vol. 203 (8), pp. 957-968.
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Typ publikacji:
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Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
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MeSH Terms:
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Mucus*
Hypoxia/*chemically induced
Hypoxia/*physiopathology
Pulmonary Disease, Chronic Obstructive/*chemically induced
Pulmonary Disease, Chronic Obstructive/*physiopathology
Pulmonary Emphysema/*chemically induced
Pulmonary Emphysema/*physiopathology
Smoking/*adverse effects
Aged ; Female ; Forced Expiratory Volume ; Healthy Volunteers ; Humans ; Male ; Middle Aged ; Respiratory Function Tests ; Smokers ; Vital Capacity
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References:
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Grant Information:
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HHSN268200900019C United States HL NHLBI NIH HHS; U24 HL141762 United States HL NHLBI NIH HHS; P30 ES005605 United States ES NIEHS NIH HHS; P01 HL107202 United States HL NHLBI NIH HHS; P01 HL128191 United States HL NHLBI NIH HHS; K23 HL123778 United States HL NHLBI NIH HHS; HHSN268200900015C United States HL NHLBI NIH HHS; HHSN268200900016C United States HL NHLBI NIH HHS; U19 AI077439 United States AI NIAID NIH HHS; U01 HL137880 United States HL NHLBI NIH HHS; HHSN268200900018C United States HL NHLBI NIH HHS; HHSN268200900013C United States HL NHLBI NIH HHS; R01 HL080414 United States HL NHLBI NIH HHS; HHSN268200900014C United States HL NHLBI NIH HHS; HHSN268200900017C United States HL NHLBI NIH HHS; HHSN268200900020C United States HL NHLBI NIH HHS
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Contributed Indexing:
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Keywords: COPD; FEV1; computed tomography; emphysema; mucus plugs
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Molecular Sequence:
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ClinicalTrials.gov NCT01969344
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Entry Date(s):
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Date Created: 20201112 Date Completed: 20210511 Latest Revision: 20240410
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Update Code:
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20240410
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PubMed Central ID:
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PMC8048745
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DOI:
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10.1164/rccm.202006-2248OC
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PMID:
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33180550
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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 FEV 1 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).
Comment in: Am J Respir Crit Care Med. 2021 Apr 15;203(8):932-934. (PMID: 33264069)
