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. 2025 Aug 4;11(4):00736-2024.
doi: 10.1183/23120541.00736-2024. eCollection 2025 Jul.

Automated computed tomographic analysis of bronchial thickness and mucus plugs in bronchiectasis with asthma

Tjeerd van der Veer  1   2 , Eleni-Rosalina Andrinopoulou  3   4 , Punitkumar Makani  5 , Gert-Jan Braunstahl  1   6 , Harm A W M Tiddens  5   7
Affiliations

Automated computed tomographic analysis of bronchial thickness and mucus plugs in bronchiectasis with asthma

Tjeerd van der Veer et al. ERJ Open Res. .

Abstract

Background: Bronchiectasis disease is characterised by cough, sputum and exacerbations, with chest computed tomography (CT) typically showing bronchial wall thickening and mucus plugging in addition to bronchial dilation. Asthma is a common comorbidity and associated with increased, eosinophilic, airway inflammation. Automated measurements of bronchial wall thickening and mucus plugs may serve as biomarkers for inflammation and are associated with clinical characteristics such as spirometry, blood eosinophil counts and disease severity in patients with bronchiectasis and asthma co-diagnosis.

Methods: In a cross-sectional retrospective cohort of 64 patients with bronchiectasis disease and asthma, we applied automated image analysis to assess bronchial dimensions and mucus plug metrics on chest CT scans. These metrics were correlated with spirometry, blood eosinophil counts as well as FACED and Bronchiectasis Severity Index (BSI) scores using correlations and multiple regression analyses.

Results: In 63 patients, bronchial wall thickness and mucus plugs were quantified. Negative correlations were observed between bronchial wall thickness markers and spirometry (bronchial wall thickness/accompanying artery diameter and forced expiratory volume in 1 s (FEV1), r= -0.37; FEV1/forced vital capacity, r= -0.30). Mucus plugs correlated negatively with spirometry and positively with FACED and BSI scores (number of mucus plugs and BSI, r=0.45). Correlations with blood eosinophil counts were very weak. In multiple regression analyses, independent associations were observed for FEV1, Pseudomonas aeruginosa and frequent exacerbations.

Conclusion: This study identified key relationships between automated measurements of bronchial wall thickness and mucus plugs and clinical characteristics, highlighting their potential as imaging biomarkers to enhance phenotyping, improve risk assessment and facilitate tailored treatment strategies in bronchiectasis.

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Conflict of interest statement

Conflict of interest: T. van der Veer reports no conflicts of interest involving the work under consideration for publication, no relevant financial activities outside the submitted work and no other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, the current manuscript. E-R. Andrinopoulou reports no conflicts of interest and no relevant financial activities or other relevant relationships or activities regarding the work under consideration. P. Makani reports no conflicts of interest and no relevant financial activities or other relevant relationships or activities regarding the work under consideration. G-J. Braunstahl reports honoraria for lectures and consultancy from GSK, AstraZeneca, Novartis and Sanofi Genzyme, as well as research grants from Sanofi Genzyme, GSK and AstraZeneca, not related to the work under consideration. H.A.W.M. Tiddens received, in the last 3 years, multiple grants from the following public and institutional grant institutions for lung structure and function research: NHMRC, NIH, CFF, ECFS, IMI and Erasmus MC Sophia Foundation; received unconditional grants for investigator-initiated research from Novartis and Insmed; acted as a consultant for Insmed, Thirona, Neupharma and Boehringer Ingelheim; and has been chief medical officer for Thirona since April 2022, and vice-chair and faculty for the ADVANCE course sponsored by Vertex.

Figures

FIGURE 1
FIGURE 1
Inclusions flowchart showing the number of participants and reasons for exclusion. ICD: International Statistical Classification of Diseases and Related Health Problems, 10th Revision; CT: computed tomography; BA: bronchus–artery; MP: mucus plug.
FIGURE 2
FIGURE 2
Bronchus–artery measures: bronchial and arterial dimensions and ratios as automatically measured by LungQ-BA.
FIGURE 3
FIGURE 3
a) Mucus plugs and b) mucus volume by Bronchiectasis Severity Index score category: mild, moderate and severe. Box plots show the median number of plugs or median total mucus volume, interquartile range (IQR) (box), smallest and largest values within 1.5×IQR (whiskers), and outliers.
FIGURE 4
FIGURE 4
Three-dimensional (3D) renderings of mucus plugs in participants with varying degrees of bronchiectasis severity: representative examples of mucus plugs in participants with a) mild, b) moderate and c) severe bronchiectasis, as categorised by the Bronchiectasis Severity Index (BSI). The 3D renderings show the bronchial tree, with mucus plugs highlighted in red. These examples represent participants with mucus plug counts near the median for their respective BSI category.
See this image and copyright information in PMC

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