Correlation of Luminal Mucus Score in Large Airways with Lung Function and Quality of Life in Severe Acute Exacerbation of COPD: A Cross-Sectional Study

Abstract

Background and Objective Luminal mucus plugging in small airways is associated with lung function decline and death of patients with chronic obstructive pulmonary disease (COPD). However, little attention has been paid to the possible role of mucus in large airways in acute exacerbation of COPD (AECOPD). Therefore, this study aimed to explore the relationship between the luminal mucus score of large airways and other physiological parameters of severe AECOPD. Subjects and Methods A total of 74 AECOPD inpatients were enrolled in this cross-sectional study. All patients underwent lung function tests and bronchoscopy, and their luminal mucus was observed and scored through bronchoscopy. Four questionnaires, including the St. George Respiratory Questionnaire (SGRQ), modified Medical Research Council dyspnea scale (mMRC), COPD Assessment Test (CAT) and Exacerbation of Chronic pulmonary disease Tool (EXACT), were used to assess health-related quality of life (HRQoL). Results The luminal mucus score of large airways was significantly correlated with spirometry parameters and HRQoL score. Both mMRC grade and SGRQ score were significantly positively correlated with luminal mucus score ( ρ =0.527, P <0.001; ρ =0.441, P <0.001, respectively). Forced expiratory flow at 25% to 75% of the FVC (FEF 25%-75% ) and FEV 1 % predicted, as functional measures reflecting small airway disease, were significantly negatively correlated with luminal mucus score ( ρ =−0.518, P <0.001; ρ =−0.498, P <0.001, respectively). The stepwise multiple linear regression model suggested that mMRC grade and FEV 1 % predicted could predict luminal mucus score ( R 2 =0.348, F =18.960, P <0.001). Conclusion For severe acute exacerbation of COPD, bronchoscopy-identified luminal mucus in large airways is associated with reduced lung function and worse health-related quality of life.

Mucus Hypersecretion and Ciliary Impairment in Conducting Airway Contribute to Alveolar Mucus Plugging in Idiopathic Pulmonary Fibrosis

“…One potential consequence of aberrant MCC in conducting airway is retention of inhaled substances (micro-organisms, cigarette smoke, air pollutants, etc. ), leading to chronic inflammation in alveolar regions and worse health-related quality of life (Yang et al, 2021). Alternatively, overexpression of mucus or hyperplasia of mucus-producing cells in the conducting airway may also promote the mucous aspirated into the distal airway and thus leading to gas exchange impairment (Leitz et al, 2021).…”

Predictive value of bronchoscopy combined with CT score for refractory mycoplasma pneumoniae pneumonia in children

“…A 2020 prospective study found substantial correlations between secretion volume, colour, mucosal oedema, and erythema, with BAL neutrophils indicating the level of airway inflammation [ 10 ]. While the BS is primarily used in assessing asthma and chronic obstructive pulmonary disease [ 22 , 23 ], its application in the quantitative assessment of pulmonary conditions in infectious pneumonia is less common [ 8 , 24 ]. Hence, this endoscopic scoring standard requires further validation through extensive studies, and there is a paucity of reports on the severity of MP assessed through bronchoscopy for endobronchial changes.…”

Targeting ATP12A, a non-gastric proton pump alpha subunit, for idiopathic pulmonary fibrosis treatment

“…etc. ), which initiates chronic inflammation in alveolar regions and reduces lung functions (52). Also, mucus accumulation may promote mucus aspiration into distal airways, impairing the gas exchange process (53).…”