TY - JOUR
T1 - Clinical associations of mucus plugging in moderate to severe asthma
AU - Chan, Rory
AU - Duraikannu, Chary
AU - Lipworth, Brian
N1 - Funding Information:
Conflicts of interest: R. Chan reports personal fees (talks) from AstraZeneca. B. Lipworth reports nonfinancial support (equipment) from GSK; grants, personal fees (consulting, talks, and advisory board), and other support (attending American Thoracic Society and European Respiratory Society) and from AstraZeneca; personal fees (talks and consulting) from Sanofi; personal fees (consulting, talks, and advisory board) from Circassia in relation to the submitted work; grants, personal fees (consulting, talks, and advisory board), and other support (attending European Respiratory Society) from Teva; personal fees (talks and consulting), grants, and other support (attending European Respiratory Society and British Thoracic Society) from Chiesi; personal fees (consulting) from Lupin; personal fees (consulting) from Glenmark, personal fees (consulting) from Vectura; personal fees (consulting) from Dr Reddy; personal fees (consulting) from Sandoz; grants, personal fees (consulting, talks, and advisory board), and other support (attending British Thoracic Society) from Boehringer Ingelheim; and grants and personal fees (advisory board and talks) from Mylan outside the submitted work; and the son of B.J. Lipworth is currently an employee of AstraZeneca. The rest of the authors declare that they have no relevant conflicts of interest.
Copyright:
© 2022 The Authors
PY - 2023/1
Y1 - 2023/1
N2 - 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 FEV 1%, forced expiratory flow at 25% to 75% of FVC percent, and FEV 1/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. FEV 1/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.
AB - 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 FEV 1%, forced expiratory flow at 25% to 75% of FVC percent, and FEV 1/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. FEV 1/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.
KW - Airway obstruction
KW - Asthma
KW - Eosinophils
KW - Exacerbations
KW - Mucus plugging
KW - Type 2 inflammation
UR - http://www.scopus.com/inward/record.url?scp=85139310714&partnerID=8YFLogxK
U2 - 10.1016/j.jaip.2022.09.008
DO - 10.1016/j.jaip.2022.09.008
M3 - Article
C2 - 36152990
SN - 2213-2198
VL - 11
SP - 195-199.e2
JO - The Journal of Allergy and Clinical Immunology: In Practice
JF - The Journal of Allergy and Clinical Immunology: In Practice
IS - 1
ER -