Mucus plugs on chest computed tomography are associated with acute exacerbations of copd in the eclipse study

SESSION TITLE: Seeing Is Believing: A Potpourri of Imaging Advances SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:55 pm - 01:40 pm PURPOSE: Luminal mucus plugs (MP) are detected on chest computed tomography (CT) in up to 67% of individuals with chronic obstructive pulmonary disease (COPD) and are associated with increased respiratory symptoms and decreased lung function. It has been suggested that blocked airways by MPs may be a nidus of infection, increasing the risk for acute exacerbations (AEs), however this has not been systematically studied in COPD. METHODS: We included participants enrolled in the multicenter, observational Evaluation of COPD Longitudinally to Identify Surrogate Endpoints (ECLIPSE) study; subjects were current or former smokers, age 40-75 years, with ≥10 pack-years of smoking who completed questionnaires, anthropomorphic measurements, post-bronchodilator spirometry, and a non-contrast chest CT at enrollment. Subjects were followed prospectively for moderate-to-severe AEs for up to 3 years. MPs were visually assessed on chest CT using a sequential reading system and were defined as an opacity which completely occluded the lumen of an airway. A MP score was generated for each CT to represent the number of bronchopulmonary segments with luminal plugs (range 0-18). Zero-inflated Poisson regression was used to examine the association between MP score and AEs, adjusting for age, sex, non-White race, pack-years, body mass index (BMI), current smoking status, forced expiratory volume in the first second (FEV1) %predicted, history of AEs in the year prior to enrollment, and CT measures of emphysema and airway wall thickness with follow-up time as an offset. A p<0.05 was considered significant. RESULTS: Subjects (n=1,682) were 63.4±7.1 (mean±SD) years old, 64% male, and 98% White, with a BMI of 26.4±5.5. Subjects were heavy smokers (median [IQR] pack-years; 44 [30, 60]) with 36.7% currently smoking. Average FEV1% predicted was 48.4±15.8, with 744 (44.2%) GOLD Grade 2, 712 (42.3%) Grade 3, and 226 (13.4%) Grade 4. CT emphysema, assessed as the fractional volume of voxels <-950HU, was 17.7% ± 12.1%, airway wall thickness was 3.94±0.20, while median MP score was 1.3±2.6. 770 subjects reported an AE in the year prior to enrollment; subjects had an average of 3.4±3.8 AEs over 2.7±0.8 years of follow-up. In multivariable-adjusted models, increasing MP score was positively associated with increased AEs (rate ratio 1.012; 95% CI [1.002-1.022], p=0.018). In subgroup analyses, continuous MP score was significantly associated with prospective AEs among females, those with a history of AE in the year prior to enrollment, and those with less severe airflow limitation (GOLD Grade 2). CONCLUSIONS: Among current and former smokers with moderate to severe COPD, radiographic MP score, a potentially modifiable airway pathology, is associated with future AEs, independent of age, lung function, and prior history of AEs. CLINICAL IMPLICATIONS: COPD patients with mucus plugging on chest CT are at increased risk for AEs and may benefit from management focused on enhanced clearance. DISCLOSURES: Grant funding relationship with Bayer Please note: 9/1/2019 Added 04/09/2023 by Michael Cho, source=Web Response, value=Grant/Research Support No relevant relationships by Alejandro Diaz No disclosure on file for Wojciech Dolliver No relevant relationships by Rim Elalami No relevant relationships by Sofia Mettler No relevant relationships by Jose Orejas No relevant relationships by Ruben San Jose Estepar No disclosure on file for Raúl San José Estépar No relevant relationships by Emily Wan No relevant relationships by Wei Wang