Targeting mucus plugs in COPD patients could help save lives

NEW DELHI: Many patients with chronic obstructive pulmonary disease (COPD) experience airway-clogging mucus plugs, an accumulation of mucus in the lungs that can affect quality of life and lung functioning. Now, a new study has found that mucus plugs are also associated with greater mortality in COPD patients.

A retrospective analysis of patient data from the COPDGene study led by researchers from Brigham and Women's Hospital in the US suggests that targeting mucus plugs could help prevent deaths from COPD.

"As a chronic disease, COPD can't be cured, but our findings suggest that using therapies to break up these mucus plugs could help improve outcomes for COPD patients, which is the next best thing," said Alejandro A Diaz, associate scientist in the Division of Pulmonary and Critical Care Medicine at the Brigham.

The findings, published in JAMA and presented simultaneously at the American Thoracic Society 2023 International Conference, could help doctors reduce the death toll of COPD, which is one of the most common and deadly respiratory diseases.

The progression of COPD can be slowed by eliminating the exposure to these pollutants, but there is no way to cure the disease. And the standard therapeutic approach for COPD has gone largely unchanged for many years.

"For the last four decades we've had only two targets for COPD therapies -- either promoting bronchial dilation, which means making the airways themselves wider, or reducing bronchial inflammation," said Diaz. "This is telling us that there may be more we can do about this disease than we realized before."

The current study included over 10,000 participants, recruited between 2007 and 2011, and included people with COPD at different stages, from the mildest to the most severe.

COPD causes the body to produce too much mucus and makes it harder to clear out, so the patients end up with these mucus plugs that aren't strongly correlated with any specific symptoms and can go undetected.

The researchers found that over the course of the study, the mortality rate for COPD patients with no detectable mucus plugs was 34 per cent. For patients with mucus plugs in up to two lung segments, the mortality rate jumped to 46.7 per cent.

For patients with plugs in three or more lung segments, the mortality rate was 54.1 per cent.

"The data show a compelling association between the accumulation of these mucus plugs and overall mortality, but we don't know anything about what's driving it yet," Diaz noted.

Because mucus is a known therapeutic target for other diseases, the researchers are next planning to test existing mucus-targeting therapies in people with COPD to determine if treating the mucus plugs could have a positive impact on patient outcomes.

"The fact that these mucus plugs were associated with mortality across different disease phases tells us that there are aspects of COPD progression that can be picked up by a CT scan even if they're not felt by the patient," said Diaz.