Quantitative CT of emphysema, wall thickness and mucus plugs in alpha-1-antitrypsin deficiency: relationship to clinical outcomes

Question Emphysema is the major structural damage in alpha-1-antitrypsin deficiency (AATD). Clinical associations of bronchial abnormalities such as bronchiectasis (BE), mucus plugs (MP) and wall thickness (WT) are lacking. Findings Quantitative CT of BE and WT correlated with PFT (p ≤ 0.05), while MP correlated with dyspnea scale (p = 0.01). The best predictor of exacerbation was WT (OR = 1.12 [1.02-1.24]). Clinical relevance AI-assisted identification of bronchial abnormalities is frequent in AATD patients in addition to emphysema alone and carries distinct clinical significance. These findings highlight the importance of comprehensive CT-based evaluations to better characterize disease phenotype and guide clinical management in AATD.