ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Mucus Plugging on Computed Tomography and Chronic Bronchitis in Chronic Obstructive Pulmonary Disease
Session Title
TP41 - TP041 DIAGNOSIS AND RISK ASSESSMENT IN COPD
Abstract
A2288 - Mucus Plugging on Computed Tomography and Chronic Bronchitis in Chronic Obstructive Pulmonary Disease
Author Block: V. Kim1, W. R. Dolliver2, H. P. Nath3, S. Grumley3, N. Terrry3, A. Ahmed3, A. S. Wen4, A. Yen5, K. Jacobs5, S. J. Kligerman5, A. Diaz6; 1Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States, 3Radiology, University of Alabama at Birmingham, Birmingham, AL, United States, 4Oakland, CA, United States, 5Radiology, University of California San Diego, San Diego, CA, United States, 6Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical Scho, Boston, MA, United States.
Introduction: The hallmark of chronic bronchitis (CB) is mucus overproduction. Mucus plugging (MP) on CT scan has been associated with decreased lung function and worse health-related quality of life in Chronic Obstructive Pulmonary Disease (COPD). How it relates to CB in COPD is unclear. We hypothesized that those with MP are more likely to have CB compared to those without MP. Methods: We analyzed 2,089 subjects with COPD from the COPDGene study. A mucus plug was defined as an opacity that completely occludes the lumen, regardless of airway size, orientation or generation. All airway paths were examined in 18 bronchopulmonary segments. An MP score was generated for each CT scan as an aggregation of the number of bronchopulmonary segments with MP (0-18). We divided subjects into those with at least one airway plugged with mucus (MP+) and those without MP (MP-). Additionally, based on prior research in asthma showing that mucus plugging of ≥4 segments was associated with worse lung function, we divided subjects into those with an MP score ≥4 and compared them to those with an MP score <4. Odds ratios for CB were calculated with MP scores using multivariable logistic regression. Covariates included demographics, lung function, smoking, and radiologic parameters. Results: Subject characteristics are presented in the Table. 658 (31.5%) subjects had mucus plugging on CT scan. 133 (6.4%) subjects had an MP score of ≥4. Compared with the MP- group, the MP+ group was more likely to have CB by either the classic definition (29.2 vs. 22.9%) or the Saint George’s Respiratory Questionnaire (SGRQ) definition (39.1 vs. 25.4%). In the MP≥4 group, the differences were more significant with 57.7% and 41.4% of the subjects having SGRQ CB and classic CB, respectively, compared to 27.6% and 23.8% of the MP<4 group. Findings were similarly significant in the MP≥4 group compared to the MP<4 group. MP+ was associated with an OR of 1.21 and 1.38 for classic CB and SGRQ CB, respectively when adjusting for covariates. Similarly, MP≥4 was associated with an OR of 1.67 and 2.05 for classic CB and SGRQ CB, respectively. Conclusions: In this well-characterized cohort of COPD subjects, MP on CT scan was significantly associated with CB. The findings suggest that imaging is a useful tool to objectively measure mucus dysfunction, a central pathophysiologic feature of CB. Further study is necessary to identify the consequences of MP on other patient reported outcomes.
Author Block: V. Kim1, W. R. Dolliver2, H. P. Nath3, S. Grumley3, N. Terrry3, A. Ahmed3, A. S. Wen4, A. Yen5, K. Jacobs5, S. J. Kligerman5, A. Diaz6; 1Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States, 2Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, United States, 3Radiology, University of Alabama at Birmingham, Birmingham, AL, United States, 4Oakland, CA, United States, 5Radiology, University of California San Diego, San Diego, CA, United States, 6Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical Scho, Boston, MA, United States.
Introduction: The hallmark of chronic bronchitis (CB) is mucus overproduction. Mucus plugging (MP) on CT scan has been associated with decreased lung function and worse health-related quality of life in Chronic Obstructive Pulmonary Disease (COPD). How it relates to CB in COPD is unclear. We hypothesized that those with MP are more likely to have CB compared to those without MP. Methods: We analyzed 2,089 subjects with COPD from the COPDGene study. A mucus plug was defined as an opacity that completely occludes the lumen, regardless of airway size, orientation or generation. All airway paths were examined in 18 bronchopulmonary segments. An MP score was generated for each CT scan as an aggregation of the number of bronchopulmonary segments with MP (0-18). We divided subjects into those with at least one airway plugged with mucus (MP+) and those without MP (MP-). Additionally, based on prior research in asthma showing that mucus plugging of ≥4 segments was associated with worse lung function, we divided subjects into those with an MP score ≥4 and compared them to those with an MP score <4. Odds ratios for CB were calculated with MP scores using multivariable logistic regression. Covariates included demographics, lung function, smoking, and radiologic parameters. Results: Subject characteristics are presented in the Table. 658 (31.5%) subjects had mucus plugging on CT scan. 133 (6.4%) subjects had an MP score of ≥4. Compared with the MP- group, the MP+ group was more likely to have CB by either the classic definition (29.2 vs. 22.9%) or the Saint George’s Respiratory Questionnaire (SGRQ) definition (39.1 vs. 25.4%). In the MP≥4 group, the differences were more significant with 57.7% and 41.4% of the subjects having SGRQ CB and classic CB, respectively, compared to 27.6% and 23.8% of the MP<4 group. Findings were similarly significant in the MP≥4 group compared to the MP<4 group. MP+ was associated with an OR of 1.21 and 1.38 for classic CB and SGRQ CB, respectively when adjusting for covariates. Similarly, MP≥4 was associated with an OR of 1.67 and 2.05 for classic CB and SGRQ CB, respectively. Conclusions: In this well-characterized cohort of COPD subjects, MP on CT scan was significantly associated with CB. The findings suggest that imaging is a useful tool to objectively measure mucus dysfunction, a central pathophysiologic feature of CB. Further study is necessary to identify the consequences of MP on other patient reported outcomes.
