AIRWAY MUCUS IMPACTION
Provided herein are, inter alia, methods and systems for detecting mucus in the lungs of a subject. Aspects provide methods and systems for the diagnosis, prognosis, characterization, detection, and treatment of asthma, chronic obstructive pulmonary disease, and type 2 inflammation.
1 . A method of treating a subject who has asthma or chronic obstructive pulmonary disease (COPD), the method comprising:
detecting an airway mucus occlusion in a lung segment of the subject; and
administering to the subject a therapeutically effective amount of a mucolytic agent or a type 2 inflammation inhibitor, wherein the subject has an airway mucus occlusion in at least one lung segment.
2 . The method of claim 1 , wherein an anticholinergic agent, a bronchodilator, or a corticosteroid is not administered to the subject.
3 . The method of claim 1 , wherein the airway mucus occlusion is an airway mucus plug.
4 . The method of any one of claims 1 to 3 , wherein detecting the airway mucus occlusion in a lung segment of the subject comprises performing multidetector computed tomography (MDCT) scan.
5 . The method of claim 4 , further comprising applying iterative reconstruction (IR) to produce images from the MDCT scan.
6 . The method of any one of claims 1 to 5 , wherein the airway mucus occlusion is farther than about 2 cm from a diaphragmatic pleura and/or a costal pleura in the subject.
7 . The method of any one of claims 1 to 6 , wherein the subject is a human subject.
8 . The method of any one of claims 1 to 7 , wherein
(a) the subject has 20 lung segments, and the lung segment is the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apical segment of the upper lobe of the left lung, the posterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, or the posterior segment of the lower lobe of the left lung;
(b) the subject has 19 lung segments, and the lung segment is the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, or the posterior segment of the lower lobe of the left lung; or
(c) the subject has 18 lung segments and the lung segment is the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anteromedial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, or the posterior segment of the lower lobe of the left lung.
9 . The method of claim 7 or 8 , wherein the subject has 18, 19, or 20 lung segments.
10 . The method of claim 9 , wherein the subject has an airway mucus occlusion in at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, or 18 lung segments.
11 . The method of claim 10 , wherein the subject has an airway mucus occlusion in at least 4 lung segments.
12 . The method of claim 10 or 11 , wherein each of the airway mucus occlusion is an airway mucus plug.
13 . The method of any one of claims 9 to 12 , wherein
(a) the subject has 20 lung segments, and the lung segments are any combination of the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apical segment of the upper lobe of the left lung, the posterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung;
(b) the subject has 19 lung segments, and the lung segments are any combination of the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung; or
(c) the subject has 18 lung segments, and the lung segments are any combination of the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anteromedial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung.
14 . The method of any one of claims 1 to 13 , wherein the asthma is chronic severe asthma.
15 . The method of any one of claims 1 to 14 , wherein the subject is incompletely responsive to a bronchodilator or a corticosteroid.
16 . The method of any one of claims 1 to 15 , wherein the mucolytic agent is a thiol-based drug, a thiosaccharide, a recombinant human DNAse, hypertonic saline, ambroxol, or an airway epithelial cell ion channel modulator.
17 . The method of claim 16 , wherein the thiol-based drug is n-acetylcysteine, carbocisteine, erdosteine, mecysteine, or a thiol saccharide.
18 . A method of treating a subject in need thereof, the method comprising administering a therapeutically effective amount of a mucolytic agent or a type 2 inflammation inhibitor to the subject, wherein the subject has an airway mucus occlusion in at least four lung segments.
19 . The method of claim 18 , wherein the subject has asthma or COPD.
20 . A method of detecting type 2 inflammation in a subject, the method comprising:
detecting an airway mucus occlusion in a lung segment of the subject; and
identifying the subject as having type 2 inflammation if subject has an airway mucus occlusion in a lung segment.
21 . The method of claim 20 , further comprising administering a therapeutically effective amount of a type 2 inflammation inhibitor to the subject.
22 . A diagnostic method comprising detecting an airway mucus occlusion in a lung segment of a subject.
23 . A method for identifying whether a subject is likely to respond or responsive to treatment with a mucolytic agent or a type 2 inflammation inhibitor, the method comprising:
detecting an airway mucus occlusion in a lung segment of a subject; and
identifying the subject as likely to respond or responsive to treatment with a mucolytic agent or a type 2 inflammation inhibitor if the subject has an airway mucus occlusion in a lung segment.
24 . A method for identifying whether a subject is unlikely to respond, incompletely responsive, or unresponsive to treatment with an anticholinergic agent, a bronchodilator, or a corticosteroid, the method comprising:
detecting an airway mucus occlusion in a lung segment of a subject; and
identifying the subject as unlikely to respond, incompletely responsive, or unresponsive to treatment with an anticholinergic agent, a bronchodilator, or a corticosteroid if the subject has an airway mucus occlusion in a lung segment.
25 . The method of any one of claims 20 to 24 , wherein the subject has asthma or COPD.
26 . The method of any one of claims 18 to 25 , wherein the airway mucus occlusion is an airway mucus plug.
27 . The method of any one of claims 18 to 26 , wherein detecting an airway mucus occlusion in a lung segment of the subject comprises performing a multidetector computed tomography (MDCT) scan.
28 . The method of claim 27 , further comprising applying iterative reconstruction (IR) to produce images from the MDCT scan.
29 . The method of any one of claims 22 to 28 , wherein the airway mucus occlusion is farther than about 2 cm from a diaphragmatic pleura and/or a costal pleura in the subject.
30 . A system, comprising:
a scanner configured to capture one or more lung images of a subject;
at least one data processor; and
at least one memory storing instructions which, when executed by the at least one data processor, result in operations comprising:
determining, based at least on the one or more lung images, a quantification of mucus plugging for the subject;
determining, based at least on the quantification of mucus plugging, a diagnosis for the subject, the diagnosis comprising a detection of an airway mucus occlusion in at least one lung segment of the subject; and
identifying, based at least on the diagnosis, one or more treatments for the subject, the one or more treatments including a therapeutically effective amount of a mucolytic agent and/or a type 2 inflammation inhibitor.
31 . The system of claim 30 , wherein an anticholinergic agent, a bronchodilator, and a corticosteroid are excluded from the one or more treatments.
32 . The system of claim 30 , wherein the airway mucus occlusion comprises an airway mucus plug.
33 . The system of any one of claims 30 to 32 , wherein the scanner is configured to perform a multidetector computed tomography (MDCT) scan of the subject.
34 . The system of claim 33 , wherein an iterative reconstruction (IR) is applied to produce the one or more lung images from the MDCT scan.
35 . The system of any one of claims 30 to 34 , wherein the airway mucus occlusion is farther than about 2 centimeters (cm) from a diaphragmatic pleura and/or a costal pleura in the subject.
36 . The system of any of claims 30 - 35 , wherein the subject is a human subject.
37 . The system of any of claims 30 to 36 , wherein
(a) the subject has 20 lung segments, and the at least one lung segment is any one of or any combination of the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apical segment of the upper lobe of the left lung, the posterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung;
(b) the subject has 19 lung segments, and the at least one lung segment is any one of or any combination the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anterior segment of the lower lobe of the left lung, the medial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung; or
(c) the subject has 18 lung segments, and the at least one lung segment is any one of or any combination of the apical segment of the upper lobe of the right lung, the posterior segment of the upper lobe of the right lung, the anterior segment of the upper lobe of the right lung, the lateral segment of the middle lobe of the right lung, the medial segment of the middle lobe of the right lung, the superior segment of the lower lobe of the right lung, the medial segment of the lower lobe of the right lung, the anterior segment of the lower lobe of the right lung, the lateral segment of the lower lobe of the right lung, the posterior segment of the lower lobe of the right lung, the apicoposterior segment of the upper lobe of the left lung, the anterior segment of the upper lobe of the left lung, the superior lingular segment of the upper lobe of the left lung, the inferior lingular segment of the upper lobe of the left lung, the superior segment of the lower lobe of the left lung, the anteromedial segment of the lower lobe of the left lung, the lateral segment of the lower lobe of the left lung, and/or the posterior segment of the lower lobe of the left lung.
38 . The system of claim 36 or 37 , wherein the at least one lung segment comprises one of 18, 19, or 20 lung segments.
39 . The system of claim 38 , wherein the airway mucus occlusion is present in at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, or 18 lung segments.
40 . The system of claim 39 , wherein the airway mucus occlusion is present in at least 4 lung segments.
41 . The system of any one of claims 30 to 40 , wherein the mucolytic agent is a thiol-based drug, a thiosaccharide, a recombinant human DNAse, hypertonic saline, ambroxol, or an airway epithelial cell ion channel modulator.
42 . The system of claim 41 , wherein the thiol-based drug is n-acetylcysteine, carbocisteine, erdosteine, mecysteine, or a thiol saccharide.
43 . The system of any of claims 30 to 42 , wherein the diagnosis includes that the subject is unlikely to respond, incompletely responsive, or unresponsive to treatment with an anticholinergic agent, a bronchodilator, or a corticosteroid.