{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:18:20Z","timestamp":1787804300240,"version":"build-2784847793"},"reference-count":11,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    A 68\u2010year\u2010old woman was hospitalized for hypoxemia during an asthma exacerbation with cough, highly tenacious sputum and exertional dyspnoea. Chest computed tomography revealed lower lobe\u2013dominant mucus plugs.\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Irpex lacteus<\/jats:italic>\n                    <\/jats:styled-content>\n                    was identified from both sputum culture and environmental sampling from the patient's bedroom, although diagnostic criteria for allergic bronchopulmonary mycosis were not fulfilled. Wheezing improved after standard therapy; however highly tenacious sputum persisted. Following administration of inhaled\n                    <jats:italic>N<\/jats:italic>\n                    \u2010acetylcysteine (NAC), sputum tenacity improved, followed by improvements in respiratory symptoms, pulmonary function test values and flow\u2010volume curves and the resolution of mucus plugs. This case suggests that highly tenacious sputum may represent a treatable trait in mucus plug\u2010forming asthma and that inhaled NAC may serve as a useful adjunctive therapy in selected patients. Further accumulation of cases is needed to clarify the clinical significance of\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Irpex lacteus<\/jats:italic>\n                    <\/jats:styled-content>\n                    colonisation.\n                  <\/jats:p>","DOI":"10.1002\/rcr2.70723","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:58:29Z","timestamp":1787050709000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inhaled\n                    <i>N<\/i>\n                    \u2010Acetylcysteine as a Potential Adjunctive Therapy in Mucus Plug\u2010Forming Asthma With\n                    <i>Irpex lacteus<\/i>\n                    Isolation: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7840-9020","authenticated-orcid":false,"given":"Yuka","family":"Uchida","sequence":"first","affiliation":[{"name":"Kanazawa Kasuga Clinic  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4601-5891","authenticated-orcid":false,"given":"Yusuke","family":"Hirao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Kanazawa Municipal Hospital  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7991-2808","authenticated-orcid":false,"given":"Koji","family":"Kurokawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Kanazawa Municipal Hospital  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3406-5554","authenticated-orcid":false,"given":"Yukari","family":"Ichikawa","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Kanazawa Municipal Hospital  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1286-7046","authenticated-orcid":false,"given":"Shiho","family":"Furusho","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Kanazawa Municipal Hospital  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4222-4929","authenticated-orcid":false,"given":"Haruhiko","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Kanazawa Kasuga Clinic  Kanazawa Japan"},{"name":"Department of Environmental and Preventive Medicine Kanazawa University  Kanazawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI95693"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12141"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.08.029"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40265\u2010026\u201002294\u20101"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2025.08.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01684\u201006"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/2045\u20107022\u20104\u201014"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.03.051"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacig.2025.100566"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046\u2010013\u20109711\u20107"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd\u20102025\u20101\u20102716"}],"container-title":["Respirology 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