Mucus plugs in chronic obstructive pulmonary disease are heterogeneous in size and shape and occur in relatively large airways
Year: 2026
Type: article
Abstract: RATIONALE: Mucus plugs occur in chronic obstructive pulmonary disease (COPD), but little is known about their size and airway location or whether these mucus plug features change as emphysema worsens. METHODS: Computed tomographic lung scans from 31 participants with COPD from the SubPopulations and InteRmediate Outcomes In COPD Study (SPIROMICS) cohort were analyzed to quantify mucus plug size and airway location and extent of emphysema. Radiologist annotations of mucus plugs were incorporated in an image processing pipeline to generate size and location information. Emphysema was quantified as the percentage of voxels less than -950 Hounsfield units. MEASUREMENTS AND MAIN RESULTS: The length distribution of 563 annotated mucus plugs varied from 2 to 50 mm. The distribution was multimodal, and an 11-mm length defined short ("stubby," ≤11 mm) and long ("stringy," >11 mm) plug phenotypes, with stubby plugs being most common (64%). Mucus plugs localized predominantly to airway generations 6 to 9, and their prevalence was highest in lower lobes. On a lobar basis, the mucus plug number decreased as emphysema percentage increased, whereas average mucus plug volume tended to increase. CONCLUSION: COPD is characterized by mucus plugs of varying size and shape, and emphysematous lung regions may be differentially susceptible to formation of these plugs. The location of mucus plugs in segmental and subsegmental airways in COPD makes them amenable to treatment with inhaled medications or bronchoscopy.
Authors: Omar N Farooqui, Brett M Elicker, Travis S Henry, Lewis D Hahn, Kimberly G Kallianos, Meilan K Han, R Graham Barr, Benjamin M Smith, Alejandro P Comellas, Jessica Bon, Nadia Hansel, J Michael Wells, Robert Paine, Igor Barjaktarevic, Joyce D Schroeder, Prescott G Woodruff, Brendan K Huang, John V Fahy
Institutions: University of California, San Francisco, Duke University, Duke Medical Center, Mayo Clinic, University of Michigan, Michigan Medicine, Columbia University Irving Medical Center, Columbia University, University of Iowa, University of Iowa Health Care, Wake Forest University Health Sciences, Wake Forest University, Johns Hopkins University, Johns Hopkins Medicine, University of Alabama at Birmingham, UAB Medicine, University of Utah, University of California, Los Angeles
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7125590837