{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T04:46:46Z","timestamp":1791694006762,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Chronic rhinosinusitis (CRS) is associated with lower airway diseases, but its relationship with mucus plugging remains unclear. We investigated the association between CRS and lower airway mucus plugging. Methods: This single-center retrospective observational study included patients who underwent paranasal sinus computed tomography and chest high-resolution computed tomography. Associations between CRS and mucus plugging were evaluated, including phenotype-stratified analyses according to eosinophilic CRS (ECRS) status. Results: Among 97 patients, 51 had CRS and 46 did not. Mucus plugging was more frequent in patients with CRS than in those without CRS (41.2% vs. 10.9%, p = 0.001), and mucus plug scores were higher in the CRS group (p = 0.002). CRS remained independently associated with mucus plugging after adjustment for asthma and bronchiectasis (adjusted odds ratio, 4.06; 95% confidence interval, 1.30\u201312.7; p = 0.016). Mucus plugging was more prevalent in both the non-ECRS and ECRS groups than in the non-CRS group, with no significant difference between the two CRS phenotypes. Conclusions: CRS remained associated with mucus plugging after adjustment for asthma and bronchiectasis. Mucus plugging may represent an underrecognized radiological feature of the lower airways in CRS.<\/jats:p>","DOI":"10.3390\/jcm15197609","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:36:31Z","timestamp":1790786191000},"page":"7609","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Rhinosinusitis Is Associated with Lower Airway Mucus Plugging"],"prefix":"10.3390","volume":"15","author":[{"given":"Akane","family":"Masuda","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4098-496X","authenticated-orcid":false,"given":"Yuta","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Motohashi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoya","family":"Aoshiba","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariko","family":"Kogami","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayuko","family":"Ishiwari","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0854-3494","authenticated-orcid":false,"given":"Ryota","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoaki","family":"Tsukahara","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/j.1398-9995.2007.01620.x","article-title":"Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)","volume":"63","author":"Bousquet","year":"2008","journal-title":"Allergy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1513\/pats.200906-052DP","article-title":"United airways concept: What does it teach us about systemic inflammation in airways disease?","volume":"6","author":"Braunstahl","year":"2009","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1398-9995.2011.02709.x","article-title":"Asthma in adults and its association with chronic rhinosinusitis: The GA2LEN survey in Europe","volume":"67","author":"Jarvis","year":"2012","journal-title":"Allergy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/j.jaip.2019.02.026","article-title":"Prevalence and clinical implications of chronic rhinosinusitis in people with bronchiectasis: A systematic review","volume":"7","author":"Handley","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9589","DOI":"10.1038\/s41598-020-66479-8","article-title":"Bidirectional association between asthma and chronic rhinosinusitis: Two longitudinal follow-up studies using a national sample cohort","volume":"10","author":"Ryu","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.amjoto.2010.07.013","article-title":"Chronic rhinosinusitis in the setting of other chronic inflammatory diseases","volume":"32","author":"Chandra","year":"2011","journal-title":"Am. J. Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1067\/mai.2001.111593","article-title":"Rhinosinusitis in severe asthma","volume":"107","author":"Bresciani","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3188","DOI":"10.1016\/j.jaip.2021.04.054","article-title":"Prevalence of bronchiectasis in patients with chronic rhinosinusitis in a tertiary care center","volume":"9","author":"Peters","year":"2021","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jaci.2022.03.006","article-title":"Strong and consistent associations of precedent chronic rhinosinusitis with risk of non-cystic fibrosis bronchiectasis","volume":"150","author":"Schwartz","year":"2022","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1172\/JCI95693","article-title":"Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction","volume":"128","author":"Dunican","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1148\/radiol.2021204616","article-title":"Mucus plugs in asthma at CT associated with regional ventilation defects at 3He MRI","volume":"303","author":"Mummy","year":"2022","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jaip.2022.09.008","article-title":"Clinical associations of mucus plugging in moderate to severe asthma","volume":"11","author":"Chan","year":"2023","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1164\/rccm.202110-2265OC","article-title":"Mucus plugs persist in asthma, and changes in mucus plugs associate with changes in airflow over time","volume":"205","author":"Tang","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.jaip.2021.12.024","article-title":"The prevalence of mucus plugging in severe eosinophilic asthma and its relationship to clinical efficacy of anti-IL-5R treatment","volume":"10","author":"Hearn","year":"2022","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"30306","DOI":"10.1038\/s41598-026-58407-z","article-title":"Clinical impact of mucus plugs in bronchiectasis","volume":"16","author":"Perea","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"00279","DOI":"10.1183\/23120541.00279-2024","article-title":"Mucus plugging, disease severity and sputum myeloperoxidase concentration in bronchiectasis","volume":"11","author":"Kim","year":"2025","journal-title":"ERJ Open Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/all.12644","article-title":"Novel scoring system and algorithm for classifying chronic rhinosinusitis: The JESREC Study","volume":"70","author":"Tokunaga","year":"2015","journal-title":"Allergy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.chest.2017.11.033","article-title":"The BRICS (Bronchiectasis Radiologically Indexed CT Score): A multicenter study score for use in idiopathic and postinfective bronchiectasis","volume":"153","author":"Bedi","year":"2018","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.2147\/JAA.S551901","article-title":"Clinical impact of mepolizumab on airway mucus plugs in patients with severe asthma","volume":"18","author":"Hara","year":"2025","journal-title":"J. Asthma Allergy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1038\/s41577-025-01159-0","article-title":"The immunology of asthma and chronic rhinosinusitis","volume":"25","author":"Kato","year":"2025","journal-title":"Nat. Rev. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.alit.2020.02.002","article-title":"The roles of IL-5 and anti-IL-5 treatment in eosinophilic diseases: Asthma, eosinophilic granulomatosis with polyangiitis, and eosinophilic chronic rhinosinusitis","volume":"69","author":"Nagase","year":"2020","journal-title":"Allergol. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"L730","DOI":"10.1152\/ajplung.00089.2003","article-title":"IL-13-induced changes in the goblet cell density of human bronchial epithelial cell cultures: MAP kinase and phosphatidylinositol 3-kinase regulation","volume":"285","author":"Atherton","year":"2003","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jaci.2015.04.041","article-title":"Eosinophil extracellular trap cell death-derived DNA traps: Their presence in secretions and functional attributes","volume":"137","author":"Ueki","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6236","DOI":"10.4049\/jimmunol.0900614","article-title":"Regulation of airway MUC5AC expression by IL-1beta and IL-17A; the NF-kappaB paradigm","volume":"183","author":"Fujisawa","year":"2009","journal-title":"J. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1165\/rcmb.2020-0168OC","article-title":"Neutrophil extracellular traps increase airway mucus viscoelasticity and slow mucus particle transit","volume":"64","author":"Linssen","year":"2021","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4009","DOI":"10.4049\/jimmunol.175.6.4009","article-title":"Neutrophil elastase induces MUC5AC mucin production in human airway epithelial cells via a cascade involving protein kinase C, reactive oxygen species, and TNF-alpha-converting enzyme","volume":"175","author":"Shao","year":"2005","journal-title":"J. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1056\/NEJMra0910061","article-title":"Airway mucus function and dysfunction","volume":"363","author":"Fahy","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1002\/alr.21370","article-title":"Chronic rhinosinusitis patients have decreased lung function","volume":"4","author":"Kariya","year":"2014","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1111\/cea.13747","article-title":"Impaired small airway function in non-asthmatic chronic rhinosinusitis with nasal polyps","volume":"50","author":"Du","year":"2020","journal-title":"Clin. Exp. Allergy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1080\/02770903.2026.2645700","article-title":"Lower airway dysfunction in patients with chronic rhinosinusitis with nasal polyps (CRSwNP): Associations with asthma, ACQ5, and inflammatory markers","volume":"63","author":"Tidemandsen","year":"2026","journal-title":"J. Asthma"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1001\/jama.2023.2065","article-title":"Airway-occluding mucus plugs and mortality in patients with chronic obstructive pulmonary disease","volume":"329","author":"Diaz","year":"2023","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1089\/jam.2000.13.239","article-title":"Impairment of airway mucociliary transport in patients with sinobronchial syndrome: Role of nitric oxide","volume":"13","author":"Tamaoki","year":"2000","journal-title":"J. Aerosol Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1378\/chest.09-0081","article-title":"Induced sputum concentrations of mucin in patients with asthma and chronic cough","volume":"137","author":"Jinnai","year":"2010","journal-title":"Chest"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"EVIDoa2300135","DOI":"10.1056\/EVIDoa2300135","article-title":"Tezepelumab and mucus plugs in patients with moderate-to-severe asthma","volume":"2","author":"Nordenmark","year":"2023","journal-title":"NEJM Evid."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S2213-2600(24)00362-X","article-title":"Effect of dupilumab on exhaled nitric oxide, mucus plugs, and functional respiratory imaging in patients with type 2 asthma (VESTIGE): A randomised, double-blind, placebo-controlled, phase 4 trial","volume":"13","author":"Castro","year":"2025","journal-title":"Lancet Respir. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1159\/000530392","article-title":"Effect of benralizumab on mucus plugs in severe eosinophilic asthma","volume":"184","author":"Sakai","year":"2023","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.3950\/jibiinkoka.106.1030","article-title":"[Effects of ESS on sinobronchial syndrome]","volume":"106","author":"Yanagi","year":"2003","journal-title":"Nihon Jibiinkoka Gakkai Kaiho"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7609\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T04:11:42Z","timestamp":1791691902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":37,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197609"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197609","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}