Airway Mucus Plugging in Chronic Bronchitis and the Impact of Bronchial Rheoplasty.

BACKGROUND: Chronic bronchitis (CB) is characterized by excessive airway mucus production. Mucus plugs occluding the airway are common in CB, are associated with increased all-cause mortality, and can be identified on CT imaging. RESEARCH QUESTION: Does bronchial rheoplasty (BR) reduce mucus plugging (MP) evident on CT imaging by basket catheter expansion and delivery of pulsed electric fields to the airway mucosa? STUDY DESIGN AND METHODS: Fifty-five patients with symptomatic CB (COPD Assessment Test cough and phlegm scores, ≥ 7 of 10) underwent bilateral BR procedures with CT performed before and 6 months after completion of the BR procedure. MP was calculated as the number detectable by CT imaging in each of 18 lung segments. Total airway count, distal airway volume (DAV; air volume within identifiable airways beyond the segmental level), and disconnected DAV (branches appearing to be disconnected from airway-occluding mucus) were assessed. RESULTS: Patients with significant CB symptoms were grouped by the presence or absence of MP at baseline. Most patients, 36 of 55 (65%), exhibited at least 1 lung segment with MP before the intervention. Notably, nearly one-third of patients (35% [19/55]) did not have MP noted on baseline imaging, despite significant self-reported CB symptoms. In patients with lung segments with MP at baseline, the mean segmental MP score was reduced by approximately 1 segment (mean [SD], -0.90 [0.33]) at follow-up from 4.3 (4.0) segments to 3.4 (3.7) segments (P = .0392), with more than one-half of patients (52.8% [19 of 36]) improving by ≥ 1 segment. Correspondingly, disconnected DAV also increased at follow-up by 16.0% (89.8%). Most patients without baseline MP (63% [12 of 19]) remained without MP at follow-up. INTERPRETATION: In this study, patients with CB who demonstrate MP on CT imaging experienced a significant mucus plug reduction at 6 months after BR, consistent with changes in patient-reported symptoms. These findings warrant further investigation. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry; No.: ACTRN 12617000330347; URL: www.anzctr.org.auClinicalTrials.gov; Nos.: NCT03107494, NCT03385616, NCT03631472; URL: www. CLINICALTRIALS: gov.

Duke Scholars

Author Joseph George Mammarappallil Radiology, Cardiothoracic Imaging