{"id":24050,"date":"2023-06-23T04:14:00","date_gmt":"2023-06-22T20:14:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24050"},"modified":"2023-06-23T06:13:45","modified_gmt":"2023-06-22T22:13:45","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9acopd%e6%82%a3%e8%80%85%e9%98%bb%e5%a1%9e%e6%b0%94%e9%81%93%e7%9a%84%e7%b2%98%e6%b6%b2%e6%a0%93","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24050","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aCOPD\u60a3\u8005\u963b\u585e\u6c14\u9053\u7684\u7c98\u6db2\u6813"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

May 21, 2023<\/p>\n\n\n\n

Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease<\/h1>\n\n\n\n

Alejandro A.\u00a0Diaz,\u00a0Jos\u00e9 L.\u00a0Orejas,\u00a0Scott\u00a0Grumley,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online May 21, 2023. doi:10.1001\/jama.2023.2065<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Are mucus plugs that occlude airways identified on computed tomography scans in patients with chronic obstructive pulmonary disease (COPD) associated with increased all-cause mortality?<\/p>\n\n\n\n

Findings<\/strong>  In this observational study that included 4363 patients with COPD, the presence of mucus plugs occluding medium- to large-sized airways (ie,\u2009approximately 2- to 10-mm lumen diameter) was significantly associated with higher risk of all-cause mortality (adjusted hazard ratio for mucus plugs affecting 1 to 2 vs 0 lung segments, 1.15; adjusted HR for mucus plugs affecting \u22653 vs 0 lung segments, 1.24).<\/p>\n\n\n\n

Meaning<\/strong>  Mucus plugs that occluded medium- to large-sized airways in patients with COPD were associated with increased all-cause mortality.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  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.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  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.<\/p>\n\n\n\n

Exposures<\/strong>  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.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  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.<\/p>\n\n\n\n

Results<\/strong>  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.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  May 21, 2023 Air […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24050"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24050"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24050\/revisions"}],"predecessor-version":[{"id":24051,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24050\/revisions\/24051"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24050"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24050"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24050"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}