![]() Asthmatic and COPD patients fulfilled the definition of the Global Initiative for Asthma 9 and the Global Initiative for Chronic Obstructive Lung Disease, 10 respectively. The subjects were classified into 3 groups: asthma (n = 49), COPD (n = 41), and ACO (n = 40) ( Fig. We retrospectively collected 130 consecutive patients who attended outpatient clinics at Shizuoka General Hospital for routine checkups and underwent HRCT scans between August 2018 and September 2020. ![]() In this retrospective study, we evaluated mucus plugs based on the visual assessment of CT lung images according to the previous studies 1, 3, 4 and investigated the relevance to pulmonary function, especially SAD and type 2 biomarkers. 9 We hypothesized that there might be some differences in clinical features with mucus plugs among asthmatic, ACO, and COPD patients. In addition, patients with the clinical features of asthma and COPD, asthma-COPD overlap (ACO), have been a clinical issue in managing asthma and COPD. ![]() Although the interpretation is still controversial, 7, 8 we adopted the forced oscillatory parameters to assess SAD in this study, including the difference between respiratory resistance at 5 and 20 Hz (R5–R20), respiratory reactance at 5 Hz (X5), low-frequency reactance area (ALX), and resonant frequency (Fres). Among the physiological tests to explore the relevance and extent of SAD in a recent large cohort asthma study (ATLANTIS), 5 we focused on the spirometric indices, including forced vital capacity (FVC) and forced expiratory flow at 25%–75% of FVC (FEF 25–75) and forced oscillation technique (FOT). 3Īlthough CT scan delineates relatively large airways from the trachea to the 6th generation bronchi, small airway dysfunction (SAD), a clinically relevant role in asthma and the primary site of airflow obstruction in COPD, 5, 6 can coexist in patients with mucus plugging. 4 Another recent study found an inverse relationship between CT scan-identified luminal plugging and FEV1 in COPD patients, but that luminal plugging was more prevalent in patients with emphysema than in those without. 1 Subsequently, the same researchers assessed the associations between mucus plugs and emphysema/airflow obstruction in smokers, including COPD patients, and found that the mucus score was associated with lower FEV1, independent of emphysema. 1, 2, 3, 4 A previous study developed a method of quantifying mucus plugs based on the visual assessment of high-resolution computed tomography (HRCT) lung images in severe asthma and found that mucus score correlated negatively with forced expiratory volume in 1 second (FEV1) and positively with sputum eosinophils. An increasing number of reports show that mucus plugs are associated with airflow obstruction in asthma and chronic obstructive pulmonary disease (COPD).
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