{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:38:36Z","timestamp":1793191116167,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"21","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,6,6]]},"abstract":"\n Importance<\/jats:title>\n Airway mucus plugs are common in patients with chronic obstructive pulmonary disease (COPD); however, the association of airway mucus plugging and mortality in patients with COPD is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Observational retrospective analysis of prospectively collected data of patients with a diagnosis of COPD in the Genetic Epidemiology of COPD cohort. Participants were non-Hispanic Black or White individuals, aged 45 to 80 years, who smoked at least 10 pack-years. Participants were enrolled at 21 centers across the US between November 2007 and April 2011 and were followed up through August 31, 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Mucus plugs that completely occluded airways on chest CT scans, identified in medium- to large-sized airways (ie,\u2009approximately\u20092- to 10-mm lumen diameter) and categorized as affecting 0, 1 to 2, or 3 or more lung segments.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was all-cause mortality, assessed with proportional hazard regression analysis. Models were adjusted for age, sex, race and ethnicity, body mass index, pack-years smoked, current smoking status, forced expiratory volume in the first second of expiration, and CT measures of emphysema and airway disease.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In participants with COPD, the presence of mucus plugs that obstructed medium- to large-sized airways was associated with higher all-cause mortality compared with patients without mucus plugging on chest CT scans.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.2065","type":"journal-article","created":{"date-parts":[[2023,5,21]],"date-time":"2023-05-21T15:30:31Z","timestamp":1684683031000},"page":"1832","source":"Crossref","is-referenced-by-count":230,"title":["Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease"],"prefix":"10.1001","volume":"329","author":[{"given":"Alejandro A.","family":"Diaz","sequence":"first","affiliation":[{"name":"Division of Pulmonary and 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