Narrative review: mucus plugging in chronic obstructive lung diseases and bronchiectasis

Area of Science:

• Pulmonary Medicine
• Radiology
• Medical Imaging

Background:

• Mucus plugging, defined as complete intraluminal occlusions, is frequently observed in high-resolution computed tomography (CT) scans of patients with obstructive lung diseases.
• It is increasingly recognized as a clinically significant finding with prognostic implications.

Purpose of the Study:

• To provide a narrative review on the pathophysiology, clinical consequences, and treatment of mucus plugging.
• To highlight the clinical relevance and prognostic value of mucus plugging in various obstructive airway diseases.

Main Methods:

• A comprehensive literature review was conducted.
• The review focused on studies detailing the pathophysiology, clinical impact, and therapeutic strategies for mucus plugging.

Main Results:

• Mucus plugging is associated with infections (e.g., Pseudomonas aeruginosa, non-tuberculosis mycobacteria) and exacerbations in bronchiectasis.
• In chronic obstructive pulmonary disease (COPD), mucus plugging correlates with increased airflow obstruction, poorer health status, higher exacerbation risk, and mortality.
• In asthma, mucus plugging is linked to severe disease and adverse outcomes.
• Existing CT scoring systems for mucus plugs are heterogeneous, limiting comparability.

Conclusions:

• Mucus plugs serve as measurable markers of disease activity with prognostic relevance across obstructive airway diseases.
• Clinical adoption is hampered by non-standardized CT scoring and a lack of plug-targeted trials.
• Emerging treatments, such as biologics (e.g., dupilumab for asthma) and azithromycin for infection prevention, show promise.
• Standardization and validation of CT-based scoring systems are essential for clinical integration.