CT Mucus Scores

As a curious patient with lots of mucus, I try to do as much reading as I possibly can. Recently, I was learning about CT mucus scores. You may be familiar with CT, or computed tomography, which is a series of x-ray equipment that can help to diagnose unexplained cough, shortness of breath, chest pain, and other symptoms.1 You may have had one as part of routine screening at the beginning of your asthma diagnosis or to rule out an asthma masquerader.

Studying mucus plugs

Multidetector computed tomography (MDCT) scans are used to evaluate mucus plugs that can be used to quantify mucus plugs on CT scans. This can aid in identifying correlations with reduced lung function, persistent airflow obstruction despite treatment, and the role of eosinophilia in asthma.2

The actual method of determining mucus scores was developed and trialed in a severe asthma research program with UCSF researchers' study. They developed a score to determine the relationship between mucus plugs and measures of airway eosinophilia. The researchers also created a visual scoring system for identifying plugs in scans.

A system for producing mucus scores

The researchers recognized mucus as "tubular densities with or without branching." The lobes were identified as "round opacities seen on sequential slices and differentiated from blood vessels." The segment scores were added together to produced a score for both lungs between 0 and 20.2 In this study, they found asthmatic patients had a median score of 3.5, which was used as a cut off to divide the subjects into zero mucus score groups, low mucus score groups (for scores of 0.5-3.5), and high mucus score groups (with scores between 4-20).2

While mucus scores are the new kids on the block in asthma, there is hope that they will be able to assist in understanding airflow obstruction. It is thought that by detecting mucus plugs by MDCT, we will then be able to identify if a mucolytic or type 2 inflammation inhibitor can decrease the number of plugs in severe asthmatics.

Other fun facts about mucus plugs

I learned that there is thought to be a difference between what is considered fibrin plugs, or plastic bronchitis, and mucus plugs. Mucus plugs are thought to occur persistently in specific airways within a patient. The pathology of these plugs includes mucin hypersecretion and eosinophil peroxidase--a “perfect storm in the focal airways”. In contrast, a fibrin plug is thought to be a plug that follows an airway bleed.3

Have you been curious about your mucus or been told you have plugs? I would love to hear about your experiences with mucus. I know it sounds gross, but I am curious. Have you had a CT to look specifically at your mucus or rule out something connected to airflow obstruction or reduced lung function?

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