Green phlegm occurs with lobular pneumonia, chronic bronchitis and bronchiectatic disease, tuberculosis. Less often, the cause of the symptom is lung mycosis, cystic fibrosis, oncological processes. Thick green phlegm occurs in chronic sinusitis. For diagnostic purposes, instrumental (radiography, CT of the lungs, bronchoscopy) and laboratory techniques (microscopic and bacteriological examination of phlegm, blood analysis) are used. The treatment plan includes antibiotics, bronchodilators, expectorants. Sometimes oxygen support and surgical interventions are prescribed.
Causes of green phlegm
Pneumonia
Expectoration of green phlegm is a typical sign of segmental or croup pneumonia. Purulent discharge with an unpleasant odor appears on the 2-4 day of the disease. The patient begins a painful coughing attack, after which a moderate amount of phlegm is released. Pneumonia is not characterized by the discharge of pus with a “full mouth”, as with destructive lung damage.
Phlegm coughing lasts 1-2 weeks. Gradually, the amount of green mucus decreases, the discharge becomes white-yellow, cloudy. In addition to this symptom, a person is concerned about dull soreness in the chest, which increases with coughing. There is a febrile temperature, general malaise, increased breathing. Patients avoid deep breaths so as not to aggravate chest pain.
Chronic bronchitis
Green thick phlegm is mainly separated from people who have been ill for 4-5 years or longer. Deformations are formed in the bronchi, which contribute to the stagnation of the mucous secretion and the reproduction of pathogenic microflora in it. For the chronic form of bronchitis, it is typical to cough up green mucus in the morning after sleep. A person has a painful cough attack, which ends with the release of phlegm. During the day, the symptom rarely bothers.
During the exacerbation of bronchitis, the volume of green phlegm increases to 200-300 ml per day. Patients complain of increased shortness of breath, weakness and malaise. Body temperature is elevated. The cough becomes permanent, combined with expectoration of thick yellow-green or gray-green mucus that has an unpleasant odor. The exacerbation lasts 2-3 weeks, after which the amount of green phlegm decreases.
Bronchiectatic disease
With this disease, there is a stagnation of the secretion in the enlarged and deformed bronchi, which is why it is infected with pathogenic bacteria. With exacerbations of the disease and coughing paroxysms, a large volume of green secretions with a fetid odor is released. Increased mucus discharge occurs after being in a lying position with the head end lowered or after breathing exercises.
For the period of remission, a scanty mucopurulent phlegm of a green hue is typical, which is released by separate spitting during a cough attack. Those suffering from bronchiectatic disease have chronic hypoxia, so patients complain of increased fatigue, dizziness, deformation of the terminal phalanges of the fingers. If pathology occurs in children, a lag in physical development is usually detected.
Chronic sinusitis
A thick green secret is formed in the paranasal sinuses, which often flows down the back wall of the pharynx, causing a cough reflex. Paroxysmal cough is more often observed in the morning, immediately after waking up, because a large amount of secretions has accumulated overnight. A person is concerned about pain and heaviness on the affected side of the face, headaches that worsen when the trunk is tilted forward.
Tuberculosis
The greenish tint of mucus is characteristic of exacerbation of the disease and massive damage to the lung tissue or for the attachment of a secondary infection. With tuberculosis, the symptom appears against the background of an increase in body temperature, intense chest pain, night sweating. Patients are disturbed by paroxysmal coughing paroxysms, accompanied by the release of scanty green phlegm, which has an unpleasant odor.
Cystic fibrosis
Symptoms of the disease are detected in childhood. In the bronchi, a viscous secret is formed in large quantities, which coughs with difficulty. The patient secretes phlegm after a prolonged painful cough. The airways are cleared much better after being in the drainage position. The discharge is thick and viscous, has a green or gray-green tint, may contain separate mucous lumps.
Often the pathology is complicated by bronchitis or pneumonia, phlegm becomes more liquid and acquires a yellow-green color. In addition to a wet cough, patients are concerned about shortness of breath, weakness, frequent inflammation of the upper respiratory tract (sinusitis, tonsillitis) with a specific clinical picture. With a mixed form of cystic fibrosis, digestive disorders are added.
Mycoses of the lungs
For fungal pneumonia, mucopurulent green phlegm is typical, expectorating in small amounts. With aspergillosis, the discharge has the appearance of dense dirty-green lumps mixed with mucus, with zygomycosis, the symptom is supplemented by hemoptysis or pulmonary bleeding. Fungal infections occur with severe intoxication. The extremely serious condition of patients is characteristic of a mixed form of pneumomycosis, concomitant immunodeficiency.
Malignant neoplasms
In bronchopulmonary cancer, the symptom occurs during the period of tumor collapse. The phlegm is abundant, dirty green or grayish, has a sharp fetid smell. It is often possible to notice brown particles of pulmonary parenchyma or streaks of blood in it. A similar clinical picture is observed in lung cancer or small bronchi. The germination of the tumor with the involvement of the pleura in the process is characterized by severe pain in the affected part of the chest.
Diagnostics
A qualified pulmonologist should identify the etiological factors that led to the release of green phlegm. During the examination, attention is paid to the symmetry of the participation of the chest in the act of breathing, signs of pulmonary insufficiency, and characteristic respiratory noises are listened to. Informative diagnosis of diseases is impossible without laboratory and instrumental methods:
- X-ray examination. An X-ray of the chest organs in direct and lateral projection shows areas of inflammatory infiltration of lung tissue, areas of compaction, contours of neoplasms. CT of the lungs helps to visualize the structure of the organ in detail. To identify signs of bronchial deformity, bronchography is used.
- FVD research. For the diagnosis of chronic bronchopulmonary diseases, spirometry is shown, according to the results of which the vital capacity of the lungs, the volume of forced exhalation and the degree of reversibility of changes are judged. To quickly assess the function of external respiration, the method of peak flowmetry is used.
- Bronchoscopy. Visualization of the bronchial tree by the endoscopic method is necessary for difficulties in differential diagnosis, if a malignant process is suspected. The method shows the condition of the bronchial mucosa, allows you to detect deformities, neoplasia. If necessary, a biopsy is taken with the help of a bronchoscope.
- Phlegm analysis. Microscopic examination of the biomaterial assesses the content of shaped blood elements, the presence of bacteria or fungal spores. Be sure to do staining on acid-resistant bacteria to exclude tuberculosis. Next, a bacteriological analysis of the discharge is performed.
Additionally, clinical and biochemical blood tests are required, in which signs of an inflammatory process are detected. To clarify the diagnosis, an MRI of the lungs is performed. Diagnostic thoracoscopy is recommended to examine the surface of the lung tissue. If the green phlegm is caused by an infection of the nasal cavity, an otolaryngologist’s consultation is prescribed with rhinoscopy and radiography of the paranasal sinuses.
Treatment
Help before diagnosis
When purulent green phlegm appears, it is very important to ensure that the respiratory tract is cleared of accumulated secretions. Patients are recommended to be in a position for postural drainage several times a day, to do breathing exercises. You can not take antitussive drugs that worsen the course of the disease. Green phlegm occurs in serious infectious or chronic processes, so self-medication is unacceptable.
Conservative therapy
Mild forms of chronic pathology are treated on an outpatient basis. Diseases that cause green phlegm often dramatically worsen the patient’s condition, therefore hospitalization is required. If there are signs of respiratory failure, oxygen support is provided. Etiopathogenetic therapy includes the following groups of drugs:
- Antibiotics. They are prescribed for the destruction of pathogenic microorganisms that cause the formation of purulent green phlegm. Antimicrobial agents are selected taking into account the results of bakposev. For the treatment of tuberculosis, special antibiotics are used in combinations of 3-4 names.
- Mucolytics. The phlegm is diluted, so that it is freely removed when coughing and does not stagnate in the bronchial tree. To enhance the effect, secretomotor agents are added that stimulate mucociliary clearance.
- Bronchodilators. They are effective for chronic diseases accompanied by difficulty breathing. The drugs expand the lumen of the bronchi, so it becomes easier for a person to breathe, and phlegm freely departs during a coughing attack.
If standard measures are ineffective, bronchoalveolar lavage and aspiration of purulent secretions are resorted to. During therapeutic bronchoscopy, intra-bronchial administration of antibacterial drugs is possible. Of the physiotherapeutic methods, vibratory chest massage, medicinal electrophoresis, inhalation are actively recommended.
Surgical treatment
In bronchiectatic disease, the affected areas of the lung are removed – segmentectomy or lobectomy. With a complicated course of pneumonia with the development of destruction zones, their excision is carried out. With destructive forms of tuberculosis, cavernectomy, thoracoplasty, pleurectomy are indicated. For patients with lung cancer, surgery is the main method of treatment and is supplemented with chemotherapy.
