@article {1675091,
	title = {Luminal Plugging on Chest CT Scan: Association With Lung Function, Quality of Life, and COPD Clinical Phenotypes},
	journal = {Chest},
	volume = {158},
	number = {1},
	year = {2020},
	month = {2020 Jul},
	pages = {121-130},
	abstract = {BACKGROUND: Mucous exudates occluding the lumen of small airways are associated with reduced lung function and mortality in subjects with COPD; however, luminal plugs in large airways have not been widely studied. We aimed to examine the associations of chest CT scan-identified luminal plugging with lung function, health-related quality of life, and COPD phenotypes.

METHODS: We randomly selected 100 smokers without COPD and 400 smokers with COPD from the COPDGene Study. Luminal plugging was visually identified on inspiratory CT scans at baseline and 5-year follow-up. The relationships of luminal plugging to FEV1, St. George{\textquoteright}s Respiratory Questionnaire (SGRQ) score, emphysema on CT scan (defined as the percentage of low attenuation area~\< 950 Hounsfield units [\%LAA-950]), and chronic bronchitis were assessed using linear and logistic multivariable analyses.

RESULTS: Overall, 111 subjects (22\%) had luminal plugging. The prevalence of luminal plugging was higher in subjects with COPD than those without COPD (25\%~vs~10\%, respectively; P~= .001). In subjects with COPD, luminal plugging was significantly associated with FEV1 \%~predicted (estimate,~-6.1; SE, 2.1; P~= .004) and SGRQ score (estimate, 4.9; SE, 2.4; P~= .04) in adjusted models. Although luminal plugging was associated with log \%LAA-950 (estimate, 0.43; SE, 0.16; P~= .007), its relationship with chronic bronchitis did not reach statistical significance (P~= .07). Seventy-three percent of subjects with COPD with luminal plugging at baseline had it 5 years later.

CONCLUSIONS: In subjects with COPD, CT-identified luminal plugging is associated with airflow obstruction, worse health-related quality of life, and emphysema phenotype. This imaging feature may supplement the current clinical assessment of chronic mucus hypersecretion in COPD.},
	keywords = {Aged, Case-Control Studies, Cohort Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Phenotype, Pulmonary Disease, Chronic Obstructive, Quality of Life, Smoking, Tomography, X-Ray Computed},
	issn = {1931-3543},
	doi = {10.1016/j.chest.2019.12.046},
	author = {Okajima, Yuka and Come, Carolyn E and Nardelli, Pietro and Sonavane, Sushil K and Yen, Andrew and Nath, Hrudaya P and Terry, Nina and Grumley, Scott A and Ahmed, Asmaa and Kligerman, Seth and Jacobs, Kathleen and Lynch, David A and Make, Barry J and Silverman, Edwin K and Washko, George R and San Jos{\'e} Est{\'e}par, Ra{\'u}l and Diaz, Alejandro A}
}