Mucus Plugs Correlate with Small Airway Remodeling in Asthma: A Case–Control Study
Bibliographic record
Abstract
RATIONALE: The observation that mucus plugs in proximal airways on computed tomography (CT) correlate with disease severity and airflow obstruction has highlighted their role in asthma. Due to the resolution of CT, it is unknown if mucus plugs within the distal small airways (<2mm in diameter) also contribute to asthma severity. OBJECTIVES: To assess the prevalence of distal mucus plugs and their association with small airway remodelling in asthma. METHODS: 12 control, 5 non-fatal, and 11 fatal asthma lungs underwent systematic uniform random sampling to obtain 239 lung tissue samples that were imaged using micro-CT and matched histology to assess mucus plugs, airway wall remodelling and mucus composition. MAIN RESULTS: Within the distal lung of non-fatal and fatal asthmatics, 30% and 38% of pre-terminal bronchioles, 29% and 34% of terminal bronchioles, and 33% and 21% of transitional bronchioles contained mucus plugs, with a high coefficient of variation in their spatial location. Mucus plugs were comprised of 84% and 82% MUC5AC and 16% and 18% MUC5B in non-fatal and fatal asthma, and 67% extended over 80% of the bronchiole pathlength. In asthmatic lungs, mucus-plugged airways had thickened airway walls, narrowed airway lumens, and luminal folding compared to unplugged airways, due to increased epithelial, basement membrane, and smooth muscle thickening. CONCLUSION: In asthma, mucus plugs are a prominent and spatially heterogeneous feature within the distal small airways, and are associated with airway wall remodelling and lumen narrowing, making them a key target for improving lung ventilation and patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".