Sex differences in bronchial mucus plugging among COPD patients

Principal Investigator: Alejandro Diaz, MD MPH

Authors: Jose Orejas, Alejandro Diaz
Lay Abstract

In heath, mucus protects the respiratory system by entrapping and moving particles out of the lung. In smoking-related conditions, such as chronic obstructive pulmonary disease (COPD), the production of mucus increases, making people bring up sputum when coughing. This increased amount of mucus also blocks the airways. In this study, we examined sex-based differences in respiratory symptoms and airway mucus plugs, using detailed images of the lungs. We found that women with COPD had higher chances of having mucus plugs and reporting shortness of breath than men with COPD. We also observed that women reported less cough and phlegm than men. These results suggest that women have a high “silent” burden of mucus plug on their lung.

Scientific Abstract

Mucus dysfunction plays a significant role in people with chronic obstructive pulmonary disease (COPD) and is characterized by increased production and reduced clearance of mucus, leading to plug formation in the airways. Whether there are sex differences in airway mucus plugging and clinical manifestations of mucus dysfunction in COPD is unknown. We aimed to test if there were sex differences in mucus plugging and respiratory symptoms associated with this COPD. We scored mucus plugging on computed tomography (CT) scans on 2,089 participants with COPD of the COPDGene cohort and used their collected clinical and spirometry data. We used multivariable logistic models to test the associations of sex with CT-based mucus plugging, cough, phlegm, and dyspnea. After adjusting for demographics, smoking history, disease severity, exacerbation history, CT measures of emphysema, and airway wall thickness, women had higher odds of mucus plugging (Odds ratio (OR) 1.41 95%CI [1.15 -1.773]) and dyspnea (Medical Research Council Dyspnea Score >1 OR 1.99 [1.58 – 2.52]) and lower odds of cough (OR 0.89 [0.73 -1.08]) and phlegm (OR 0.64 [0.53 – 0.77]). We conclude that among patients with COPD, women had higher odds of airway mucus plug formation and dyspnea while reporting lower odds of cough and phlegm.

Clinical Implications
These findings increase our understanding of clinical and imaging manifestations of mucus dysfunction in patients with COPD and may inform further investigation on therapies for this process.

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