Observational studyThe Journal of clinical investigation2018
Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction.
Observational study in The Journal of clinical investigation, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 10 registered trials, which are not on this map. Cited by 320 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Severe Asthma Research Program
Severe Asthma Research Program (SARP)-Washington University
Clinical and Molecular Phenotypes of Severe Asthma
The Severe Asthma Research Program at Wake Forest University - Longitudinal Phenomics and Genetics of Severe Asthma.
Severe Asthma Research Program
Severe Asthma Research Program (SARP) - University of Wisconsin
ALXR/FPR Mediated Signaling in Severe Asthma (AMSA)-The Severe Asthma Research Program (SARP) III
A Two-arm, Placebo-controlled, Randomized Clinical Trial to Evaluate the Effect of Tezepelumab on Airway Structure and Function in Patients With Uncontrolled Moderate-to-severe Asthma
Airway Dysfunction, Occlusions and RemodEling: COPD Patients and Mepolizumab (ADORE)
Who cites it
320 citing papers in PubMed, 5 syntheses or guidelines pooled it, 572 citations in OpenAlex.
- Effectiveness of biologics for reducing occlusive mucus plugs in patients with severe asthma: a systematic review.Respiratory research · 2026Pooled it
- Inflammatory and clinical risk factors for asthma attacks (ORACLE2): a patient-level meta-analysis of control groups of 22 randomised trials.The Lancet. Respiratory medicine · 2025Pooled it
- The clinical and pathological histology efficacy of biological therapy for severe asthma with a phenotype of type 2 inflammation - systematic review.Frontiers in immunology · 2025Pooled it
- Efficacy of Biologics in Severe, Uncontrolled Asthma Stratified by Blood Eosinophil Count: A Systematic Review.Advances in therapy · 2023Pooled it
- Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis.The Journal of allergy and clinical immunology · 2023Pooled it
- Development of Pediatric Dosing for Mepolizumab in Severe Asthma Based on Extrapolation of Data From Adult Patients and a Phase II Open-Label Pediatric Trial.Journal of clinical pharmacology · 2026Trial
- Effect of Tezepelumab on Lung Function in Patients With Severe, Uncontrolled Asthma in the Phase 3 NAVIGATOR Study.Advances in therapy · 2023Trial
- Restoring the Airway Barrier: How Targeting Eosinophilic Inflammation Shapes Epithelial Health and Clinical Remission in Asthma.Diagnostics (Basel, Switzerland) · 2026Review
- Airway mucus plugs in asthma and chronic obstructive pulmonary disease: pathobiology, imaging, and implications for clinical trials.American journal of respiratory and critical care medicine · 2026Review
- Effectiveness of mepolizumab on mucus plugs and clinical outcomes in severe eosinophilic asthma with and without coexisting bronchiectasis: a prospective pilot study.ERJ open research · 2026Article
- Is Asthma Remission a New Achievable Goal? A Review of the Current Drug-Related Evidence and Predictors.Allergy · 2026Review
- Computed tomography-derived pulmonary blood volume distribution may be modifiable in asthma.ERJ open research · 2026Article
- COPD Biologics: Right Patient, Right Pathway, Right Time.Pulmonary therapy · 2026Review
- Chest CT imaging toward personalized management of chronic obstructive pulmonary disease, asthma, and bronchiectasis: pulmonologist perspectives.Japanese journal of radiology · 2026Review
- Respiratory Support in Pediatric Critical and Near-Fatal Asthma: A Narrative Review.Pulmonary therapy · 2026Review
- Review
- Association of Airway Mucus Plugs and Physical Activity, Exercise Tolerance, Sarcopenia, and Frailty in Patients With COPD and Pre-COPD.Respirology (Carlton, Vic.) · 2026Observational
- Fabrication of Budesonide-Encapsulated β-Glucan Nanoparticles for Alleviation of Acute Bronchial Asthma via Modulation of the p38 MAPK Signaling Pathway.Applied biochemistry and biotechnology · 2026Article
- Article
- Bronchial Wall T2-Weighted MRI Signal: An Emerging Investigational Non-Ionizing Imaging Biomarker in Severe Asthma.Biomedicines · 2026Article
260 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
26 authors at 10 institutions in 2 countries.
Funding
Abstract
backgroundThe link between mucus plugs and airflow obstruction has not been established in chronic severe asthma, and the role of eosinophils and their products in mucus plug formation is unknown.
methodsIn clinical studies, we developed and applied a bronchopulmonary segment-based scoring system to quantify mucus plugs on multidetector computed tomography (MDCT) lung scans from 146 subjects with asthma and 22 controls, and analyzed relationships among mucus plug scores, forced expiratory volume in 1 second (FEV1), and airway eosinophils. Additionally, we used airway mucus gel models to explore whether oxidants generated by eosinophil peroxidase (EPO) oxidize cysteine thiol groups to promote mucus plug formation.
resultsMucus plugs occurred in at least 1 of 20 lung segments in 58% of subjects with asthma and in only 4.5% of controls, and the plugs in subjects with asthma persisted in the same segment for years. A high mucus score (plugs in ≥ 4 segments) occurred in 67% of subjects with asthma with FEV1 of less than 60% of predicted volume, 19% with FEV1 of 60%-80%, and 6% with FEV1 greater than 80% (P < 0.001) and was associated with marked increases in sputum eosinophils and EPO. EPO catalyzed oxidation of thiocyanate and bromide by H2O2 to generate oxidants that crosslink cysteine thiol groups and stiffen thiolated hydrogels.
conclusionMucus plugs are a plausible mechanism of chronic airflow obstruction in severe asthma, and EPO-generated oxidants may mediate mucus plug formation. We propose an approach for quantifying airway mucus plugging using MDCT lung scans and suggest that treating mucus plugs may improve airflow in chronic severe asthma.
trial registrationClinicaltrials.gov NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01759186, NCT01716494, and NCT01760915.
fundingNIH grants P01 HL107201, R01 HL080414, U10 HL109146, U10 HL109164, U10 HL109172, U10 HL109086, U10 HL109250, U10 HL109168, U10 HL109257, U10 HL109152, and P01 HL107202 and National Center for Advancing Translational Sciences grants UL1TR0000427, UL1TR000448, and KL2TR000428.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.