The journal of allergy and clinical immunology. Global · 2025
Clinical and pathophysiological roles of lower lobe-dominant mucus plugs on computed tomography in patients with asthma with and without bronchiectasis.
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Tanabe Naoya, Matsumoto Hisako, Nomura Natsuko, Hayashi Yusuke, Sakamoto Ryo, Toyoshima Mikio, Matsuno Osamu, Kita Toshiyuki, Hizawa Nobuyuki, Sakagami Takuro, Fukunaga Koichi, Miki Mari, Hashimoto Naozumi, Hattori Noboru, Inoue Sumito, Matsunaga Kazuto, Otsuka Kojiro, Tsuburai Takahiro, Iijima Hiroaki, Nagase Hiroyuki, Nakamura Morio, Kawamura Tetsuji, Kijima Takashi, Tsuji Taisuke, Sunadome Hironobu, Sato Susumu, Sato Atsuyasu, Hirai Toyohiro
Аннотация
BACKGROUND: Despite the clinical relevance of mucus plugging, the role of spatial distribution of mucus plugs remains unclear in patients with asthma.
OBJECTIVE: We sought to examine whether greater lower lobe mucus plug dominance is associated with more clinical and pathophysiological impairments in 2 cohorts, including patients with and without bronchiectasis.
METHODS: Patients with asthma without and with clinical diagnosis of bronchiectasis underwent chest computed tomography at Kyoto University Hospital (Kyoto cohort) and Japanese multicenters (bronchiectasis and asthma [BEXAS] cohort), respectively. Mucus plugs in airways were visually scored on computed tomography, and the difference in mucus plug score between lower and upper-middle lobes (Δ mucus plug score) was calculated.
RESULTS: Among 176 (Kyoto) and 42 (BEXAS) enrolled patients, 82 and 33 exhibited mucus plug scores greater than or equal to 1, respectively. Higher Δ mucus plug score was associated with lower percentage of the predicted FEV1 and the presence of exacerbation history in both cohorts. Higher Δ mucus plug score was associated with luminal narrowing of the fifth-generation, but not the third- or fourth-generation, lower lobe airways in the Kyoto cohort, and bronchiolitis score in the BEXAS cohort. In the multivariable model, higher Δ mucus plug score was associated with symptoms and exacerbations, independent of whole-lung mucus plug score in the Kyoto cohort.
CONCLUSIONS: Lower lobe-dominant mucus plugs were associated with lower lung function and exacerbations in patients with asthma, irrespective of comorbid bronchiectasis. The spatial distribution of mucus plugs additionally to whole-lung mucus plug score may help to understand clinical roles of mucus plugging in asthma.
OBJECTIVE: We sought to examine whether greater lower lobe mucus plug dominance is associated with more clinical and pathophysiological impairments in 2 cohorts, including patients with and without bronchiectasis.
METHODS: Patients with asthma without and with clinical diagnosis of bronchiectasis underwent chest computed tomography at Kyoto University Hospital (Kyoto cohort) and Japanese multicenters (bronchiectasis and asthma [BEXAS] cohort), respectively. Mucus plugs in airways were visually scored on computed tomography, and the difference in mucus plug score between lower and upper-middle lobes (Δ mucus plug score) was calculated.
RESULTS: Among 176 (Kyoto) and 42 (BEXAS) enrolled patients, 82 and 33 exhibited mucus plug scores greater than or equal to 1, respectively. Higher Δ mucus plug score was associated with lower percentage of the predicted FEV1 and the presence of exacerbation history in both cohorts. Higher Δ mucus plug score was associated with luminal narrowing of the fifth-generation, but not the third- or fourth-generation, lower lobe airways in the Kyoto cohort, and bronchiolitis score in the BEXAS cohort. In the multivariable model, higher Δ mucus plug score was associated with symptoms and exacerbations, independent of whole-lung mucus plug score in the Kyoto cohort.
CONCLUSIONS: Lower lobe-dominant mucus plugs were associated with lower lung function and exacerbations in patients with asthma, irrespective of comorbid bronchiectasis. The spatial distribution of mucus plugs additionally to whole-lung mucus plug score may help to understand clinical roles of mucus plugging in asthma.