Available online 21 September 2022
Highlights boxWhat is already known about this topic?
Different studies have shown that mucus plugging in asthma is associated with worse spirometry, greater type 2 inflammation and more frequent severe exacerbations.
What does this article add to our knowledge?
Here we determine clinical associations with mucus plugging in moderate-to-severe asthma in the same study.
How does this study impact current management guidelines?
Mucus plugging should be included as an important aspect of routine severe asthma workup for tailoring biologic decisions.
AbstractBackgroundMucus plugging (MP) is recognised as a contributory factor to airway obstruction and symptoms in persistent asthma.
ObjectiveWe aimed to determine phenotypic associations of mucus plugging in patients with moderate-to-severe asthma in a real-life clinic setting.
MethodsMPs were identified by a thoracic radiologist on high resolution CT imaging. A MP score was subsequently calculated and analysed along with type 2 (T2) biomarkers, spirometry, severe exacerbations and asthma control for 126 moderate to severe asthma patients prior to biologic therapy.
ResultsAsthma patients with MP had significantly worse FEV1%, FEF25-75% and FEV1/FVC; higher levels of peripheral blood eosinophils, fractional exhaled nitric oxide, total IgE and A. fumigatus IgE titres; and experienced more frequent prior severe exacerbations. FEV1/FVC, ≥2 exacerbations/yr, blood eosinophils, total IgE and A. fumigatus IgE titres were associated with MP after adjusting for confounders.
ConclusionsPoorly controlled asthma patients with MP exhibited significantly worse airflow obstruction, greater T2 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 MP.
Key wordsmucus plugging
asthma
eosinophils
type 2 inflammation
airway obstruction
exacerbations
AbbreviationsABPAallergic bronchopulmonary aspergillosis
ACQAsthma Control Questionnaire
ATSAmerican Thoracic Society
ERSEuropean Respiratory Society
FeNOfractional exhaled nitric oxide
FEV1forced expiratory volume in 1 second
HRCThigh resolution computed tomography
ICSinhaled corticosteroids
LABAlong-acting beta-agonist
LAMAlong-acting muscarinic-antagonist
LTRAleukotriene receptor antagonist
PBEperipheral blood eosinophils
© 2022 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
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