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However, clinical phenotypes relevant to mucus plugs, including sarcopenia and frailty, are not fully elucidated. This study aimed to investigate the association between mucus plugs, sarcopenia, and frailty using a prospective observational COPD\u2010enriched smoker cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional analysis, patients with COPD and pre\u2010COPD were classified into no\u2010, low\u2010, and high\u2010mucus groups according to mucus scores on CT. The risks of frailty and sarcopenia, and relevant clinical, functional, and imaging factors including 6\u2010min walk distance (6MWD), physical activity, body compositions via bioelectrical impedance analysis (BIA), and intra\u2010 and extrapulmonary CT indices were compared between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 175 patients (142 COPD, 33 pre\u2010COPD, and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009106, 48, and 21 in the no\u2010, low\u2010, and high\u2010mucus groups), the high\u2010mucus group was associated with increased odds ratio for sarcopenia independent of age, sex, height, smoking, and forced expiratory volume in 1\u2009s, or emphysema and wall area percentage (WA%). The high\u2010mucus group demonstrated increased airtrapping and WA%, reduced total airway count, and decreased muscle and fat mass (assessed by both BIA and CT), while emphysema was not different. Furthermore, 6MWD deteriorated in the high\u2010mucus group independent of age, sex, height, and smoking, whereas physical activity did not differ.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with COPD and pre\u2010COPD, mucus plugs are associated with reduced muscle and fat mass and a heightened sarcopenia risk.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/resp70273-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70273","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:35:03Z","timestamp":1781231703000},"page":"893-902","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Airway Mucus Plugs and Physical Activity, Exercise Tolerance, Sarcopenia, and Frailty in Patients With\n                    <scp>COPD<\/scp>\n                    and Pre\u2010\n                    <scp>COPD<\/scp>"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-5673","authenticated-orcid":false,"given":"Yusuke","family":"Shiraishi","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Graduate School of Medicine Kyoto University  Kyoto 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