Background

Mucus plugging is recognized as a contributory factor to airway obstruction and symptoms in persistent asthma.

Objective

We aimed to determine phenotypic associations of mucus plugging in patients with moderate to severe asthma in a real-life clinic setting.

Methods

Mucus plugs (MPs) were identified by a thoracic radiologist upon high-resolution computed tomography imaging. A MP score was subsequently calculated and analyzed along with type 2 biomarkers, spirometry, severe exacerbations, and asthma control for 126 patients with moderate to severe asthma before biologic therapy.

Results

Asthma patients with MP had significantly worse FEV₁%, forced expiratory flow at 25% to 75% of FVC percent, and FEV₁/FVC as well as higher levels of peripheral blood eosinophils, FeNO, total IgE, and Aspergillus fumigatus IgE titers, and had previously experienced more frequent severe exacerbations. FEV₁/FVC, more than two exacerbations per year, blood eosinophils, total IgE, and A fumigatus IgE titers were associated with MPs after adjusting for confounders.

Conclusions

Poorly controlled asthma patients with MPs exhibited significantly worse airflow obstruction and greater type 2 inflammation associated with more frequent severe exacerbations. Impaired spirometry, more frequent exacerbations, raised blood eosinophils, total IgE, and A fumigatus IgE increased the likelihood of MPs.

中文翻译：

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粘液堵塞在中度至重度哮喘中的临床关联

背景

粘液堵塞被认为是气道阻塞和持续性哮喘症状的促成因素。

客观的

我们的目的是确定在现实生活中的临床环境中，粘液堵塞与中度至重度哮喘患者的表型关联。

方法

粘液栓 (MPs) 由胸部放射科医生根据高分辨率计算机断层扫描成像识别。随后计算并分析了 126 名在生物治疗前患有中度至重度哮喘的患者的 MP 评分以及 2 型生物标志物、肺活量测定、严重恶化和哮喘控制。

结果

患有 MP 的哮喘患者的 FEV ₁ %、用力呼气流量为 FVC 百分比的 25% 至 75% 和 FEV ₁ /FVC 以及外周血嗜酸性粒细胞、FeNO、总 IgE 和烟曲霉IgE 滴度的水平更高，并且之前经历过更频繁的严重恶化。FEV ₁ /FVC、每年超过两次急性加重、血液嗜酸性粒细胞、总 IgE 和烟曲霉IgE 滴度在调整混杂因素后与 MPs 相关。

结论

控制不佳的 MP 哮喘患者表现出明显更严重的气流阻塞和更严重的 2 型炎症，与更频繁的严重恶化相关。肺功能受损、更频繁的加重、血液嗜酸性粒细胞升高、总 IgE 和烟曲霉IgE 增加了 MPs 的可能性。