Rationale/Objective: Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality. Whether mucus plugs are associated with prospective exacerbations has not been examined extensively. METHODS Mucus plugs were visually-identified on baseline chest computed tomography (CT) scans from smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 2-4 COPD enrolled in two multicenter cohort studies: Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and COPDGene. Associations between ordinal mucus plug score categories (0/1-2/≥3) and prospectively-ascertained AEs, defined as worsening respiratory symptoms requiring systemic steroids and/or antibiotics (moderate-to-severe) and/or ER/hospitalization (severe), were assessed using multivariable-adjusted zero-inflated Poisson regression; subjects were exacerbation-free at enrollment. RESULTS Among 3,250 participants in COPDGene (mean±SD age 63.7±8.4 years, FEV1 50.6%±17.8% predicted, 45.1% female) and 1,716 participants in ECLIPSE (age 63.3±7.1 years, FEV1 48.3%±15.8% predicted, 36.2% female), 44.4% and 46.0% had mucus plugs, respectively. The incidence rates of AEs were 61.0 (COPDGene) and 125.7 (ECLIPSE) per 100 person-years. Relative to those without mucus plugs, the presence of 1-2 and ≥3 mucus plugs was associated with increased risk (adjusted rate ratio, aRR [95%CI]=1.07[1.05-1.09] and 1.15[1.1-1.2] in COPDGene; aRR=1.06[1.02-1.09] and 1.12[1.04-1.2] in ECLIPSE, respectively) for prospective moderate-to-severe AEs. The presence of 1-2 and ≥3 mucus plugs was also associated with increased risk for severe AEs during follow-up (aRR=1.05[1.01-1.08] and 1.09[1.02-1.18] in COPDGene; aRR=1.17[1.07-1.27] and 1.37[1.15-1.62] in ECLIPSE, respectively). CONCLUSION CT-based mucus plugs are associated with an increased risk for future COPD AEs.

中文翻译：

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胸部计算机断层扫描显示气道黏液栓与 COPD 急性加重有关。


基本原理/目标： 慢性阻塞性肺病 （COPD） 的急性加重 （AE） 与显着的发病率和死亡率相关。粘液栓是否与预期恶化有关尚未得到广泛检查。方法 在慢性阻塞性肺病全球倡议 （GOLD） 2-4 级 COPD 的吸烟者的基线胸部计算机断层扫描 （CT） 扫描中目视识别粘液栓，该研究参加了两项多中心队列研究：纵向评估 COPD 以确定预测替代终点 （ECLIPSE） 和 COPDGene。顺序粘液栓评分类别 （0/1-2/≥3） 与前瞻性确定的 AE 之间的关联，定义为需要全身性类固醇和/或抗生素的呼吸系统症状恶化（中度至重度）和/或 ER/住院（重度），使用多变量调整零充气泊松回归进行评估;受试者在入组时无恶化。结果 在 3,250 名 COPDGene 参与者 （平均 ±SD 年龄 63.7±8.4 岁，FEV1 50.6%±预测 17.8%，45.1% 女性）和 1,716 名 ECLIPSE 参与者 （年龄 63.3±7.1 岁，FEV1 预测 48.3%±15.8%，女性 36.2%）中，分别有 44.4% 和 46.0% 有粘液栓。AEs 的发生率为 61.0 （COPDGene） 和 125.7 （ECLIPSE） /100 人年。相对于没有粘液栓的患者，存在 1-2 和 ≥3 个粘液栓与前瞻性中度至重度 AE 的风险增加相关 （调整率比，COPDGene 中 aRR [95%CI] =1.07[1.05-1.09] 和 1.15[1.1-1.2];ECLIPSE 中分别为 aRR=1.06[1.02-1.09] 和 1.12[1.04-1.2]）。1-2 和 ≥3 粘液栓的存在也与随访期间严重 AE 的风险增加相关 （COPDGene 中的 aRR=1.05[1.01-1.08] 和 1.09[1.02-1.18];aRR=1.17[1.07-1.27] 和 1.37[1.15-1.62]。结论 基于 CT 的粘液栓与未来 COPD AE 的风险增加有关。