The Growing Importance of Measuring Mucus Plugs in Respiratory Trials

There is growing interest in how mucus, specifically mucus plugs, impacts lung diseases such as chronic obstructive pulmonary disease (COPD), bronchiectasis, and asthma. New research is shedding light on mucus' role in the disease process and its impact on clinical outcomes, medication requirements, and more. In response, mucus plugs have become an important target for emerging pharmacological treatments. Therefore, the ability to quantitatively measure mucus plugging has become increasingly important; however, ­it remains ­a challenging task because of the intricacies of the airway system. To address this challenge, VIDA has developed a specialized AI-driven workflow that empowers fast, reliable mucus scoring for clinical trials involving airway disease.


What is a Mucus Plug?

Mucus itself is a vital and natural bodily function that helps defend and hydrate airway passages. Mucus plugs occur when a surplus of thicker mucus accumulates, clogs, and reduces airflow. The composition of mucus plugs can vary, and those key differences are meaningful. Patients with chronic airway diseases such as COPD and asthma have higher baseline levels of mucus. Minor exacerbations of their disease, in conjunction with genetic and environmental irritants, can further increase the occurrence of mucus plugs.


Mucus Scoring in COPD and Asthma Clinical Trials

Mucus dysfunction is a key pathophysiological feature of COPD. Plug are common in those with many forms of COPD.  In fact, a recent study found that 31.5% of COPD patients have mucus plugging. In about a third of cases, these plugs are "silent," meaning the patient isn't aware of them symptomatically, but they are detectable through CT imaging. 

Mucus plugs are even more common in asthma patients--Dunican and colleagues found plugs in 58% of asthma patients. She also noted that asthma patients with significant mucus plugs are more likely to have higher medication requirements, worse asthma control test scores, and be classified as “severe asthma” patients. Understanding the severity and type of plugging in these patients is increasingly important in asthma clinical trials. Dunican and colleagues suggest:

“We show that the clinical and airway inflammation features of the CMH (chronic mucus hypersecretion) phenotype are different from the features of the mucus plug phenotype. Thus, not all mucus phenotypes in asthma are the same, and we demonstrate the unique ability of CT lung imaging to identify patients with a mucus plug phenotype.”


VIDA's Approach to Mucus Plug Quantification

Researchers have recently defined new mucus scoring methodologies that enable consistent quantification of the mucus burden. The challenge is that each case has a minimum of 558 airway segments to inspect for plugs and as many as 1,334. Such an extensive search using traditional tools can be resource intensive. VIDA has built a custom, semi-automated, AI-driven mucus scoring workflow to empower radiologists in performing this analysis with ease. This proprietary workflow results in a highly efficient process for scoring mucus, along with high confidence in the results. For pharmaceutical vendors considering the addition of mucus scoring in their trials, VIDA enables a high quality, cost-effective path to include this powerful new biomarker.

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