Purulent sputum is a pathological discharge of the bronchi and trachea containing a large number of white blood cells, colored yellow, yellow-green or green. This symptom accompanies severe inflammation of the bronchial wall, observed in suppurative and neoplastic processes of the pulmonary parenchyma and pleura. Imaging and endoscopic diagnostic methods, as well as laboratory tests, are used to determine the cause of purulent sputum discharge during coughing. The choice of treatment tactics depends on the underlying disease.
Causes of purulent sputum
Purulent bronchitis
The discharge of secretions with an admixture of pus is often observed with an infectious lesion of the mucous membranes of the tracheobronchial tree. Purulent sputum in a patient with acute bronchitis indicates the attachment of bacterial microflora. The disease acquires a protracted course. A dry or unproductive cough with a small amount of viscous mucus is replaced by a wet one. Sputum becomes semi-liquid.
Purulent lumps appear in the mucus separated from purulent bronchitis, or the sputum is completely colored green. Cough is usually accompanied by intoxication and bronchoobstructive syndromes. In patients with chronic bronchitis, purulent sputum can be coughed up daily, during the period of exacerbation of the disease, the amount of discharge increases.
Bronchiectasis
A common cause of purulent secretion with cough is the presence of pathological segmental bronchial extensions – bronchiectasias. Such formations may be congenital or develop against the background of respiratory defects. In bronchiectasis, mucus stagnates. Sputum becomes infected and becomes purulent. Bronchiectatic disease is formed, which usually manifests in childhood.
The disease is manifested by a constant cough in the morning. Sputum is usually purulent, coughing profusely. During an exacerbation, the volume of discharge increases and often reaches 400 ml, body temperature rises, general weakness appears, and appetite decreases. Bronchiectatic disease is often complicated by hemoptysis. As the pathology progresses, shortness of breath increases, symptoms of a chronic pulmonary heart appear.
The appearance of pus in bronchial secretions in adults is often caused by the formation of secondary bronchiectasias against the background of chronic bronchopulmonary pathology. The most common cause of such complications is COPD. The disease is characterized by slowly increasing shortness of breath, cough. With exacerbation, purulent sputum departs, there are signs of intoxication. Bronchiectasis aggravates the course of this pathology and worsens the prognosis.
Lung abscess
A large amount of purulent sputum when coughing is separated from destructive diseases of the pulmonary parenchyma. Lung abscess is more often observed in patients with reduced immunity, in people suffering from alcohol or drug addiction, as well as during aspiration of oral secretions and vomit. As a result of the activity of anaerobic bacteria or microbial associations, local purulent melting of lung tissue occurs.
The abscess is more often localized in the upper lobe of the right lung. At the first stage of the development of the disease, the cough is unproductive, viscous mucus departs. There are pains on the affected side of the chest, febrile and hyperthermic fever, pronounced weakness. With good drainage of the abscess in the bronchi, the discharge becomes abundant and often fetid. Purulent green sputum leaves with a “full mouth”, after which the state of health improves.
The disease acquires a chronic course with poor drainage of the abscess, inadequate antibacterial therapy, and violations of the functions of the patient’s immune system. During remission, mucopurulent sputum is coughed up, exacerbation is accompanied by an increase in the volume of pathological secretions. What is separated acquires a green tint, a putrid smell appears.
Lung gangrene
Widespread purulent destruction captures the lobe or lung entirely. It develops in immunocompromised individuals, people with alcoholism, drug addiction. It proceeds extremely hard with a high lethality. Intoxication is pronounced. Lung gangrene is characterized by a constant debilitating fever or a hectic type of temperature rise. Periods of apparent improvement are replaced by a sharp deterioration, indicating the spread of necrosis.
Sputum is purulent, characterized by a pronounced stench. After an attack of painful coughing, an abundant brown-green or dirty-gray discharge is expectorated. Its volume can be 1000 ml or more. When parenchymal bleeding is attached, sputum departs in the form of raspberry-colored mucus. Purulent semi-liquid mass, isolated by patients with abscess or gangrene of the lungs, forms 3 layers when settling.
Bronchopulmonary carcinoma
In patients suffering from lung and bronchial cancer, purulent sputum is coughed up in the phase of tumor decay. This process is observed in the terminal stage of the disease, or against the background of radiation or chemotherapy. Copious discharge of pus with an unpleasant odor is accompanied by a sharp aggravation of the patient’s condition due to the release of toxic decomposition products into the body.
Other reasons
Suppuration of mucus secreted by the bronchial glands is possible if there is a cavity formation of any etiology drained by the bronchus in the lungs as a result of infection with bacterial microflora. Purulent sputum is abundantly separated when the empyema of the pleura breaks into the respiratory tract. Other reasons for coughing up such a pathological secret include:
- Specific infections: fibrotic cavernous tuberculosis.
- Pulmonary mycoses: actinomycosis.
- Suppurated cysts.
Diagnostics
Diagnostic search for the causes of expectoration of pus or fetid mucus with a large number of yellow-green inclusions is carried out by pulmonologists. When collecting anamnesis, the prescription of the disease, the treatment performed are specified. The examination reveals signs of acute or chronic respiratory failure. To finally determine why the patient coughs up purulent sputum, you can use the following diagnostic measures:
- Physical examination. Percussion is determined by the dulling of sound in the projection of the compaction of lung tissue. Auscultation with bronchitis against the background of hard breathing, dry whistling and buzzing wheezes are heard. In the presence of gangrene or abscess, breathing in the infiltration zone becomes bronchial, moist crepitating, medium- and small-bubbly wheezes are detected.
- Visualization techniques. An overview chest X-ray reveals infiltration zones with signs of destruction, thick-walled drained abscesses with a horizontal fluid level, decaying tumors. Bronchiectasias are visualized using bronchography, CT, and MRI of the respiratory organs.
- Endoscopic methods. Fibrobronchoscopy in some cases is a therapeutic and diagnostic manipulation. This method allows you to identify signs of purulent bronchitis, get bronchial lavage for further research. If necessary, a biopsy of the suspicious area is performed. With the help of bronchoscopy, the tracheobronchial tree is sanitized.
- Laboratory tests. The suppurative process is accompanied by pronounced changes characteristic of inflammation from the peripheral blood. Purulent sputum, having settled, stratified with the formation of 2 or 3 layers. Microscopically, a significant number of leukocytes and pathological inclusions are detected in it. Dietrich plugs are detected in BEB, atypical cells are detected in tumors, elastic fibers are characteristic of abscess and gangrene.
Treatment
Help before diagnosis
Purulent sputum is most often a sign of a serious, often life-threatening disease and requires urgent treatment in a medical institution. When this symptom is combined with difficulty breathing, severe intoxication and other severe manifestations of the disease, an emergency request for medical help is indicated. With concomitant fever, an antipyretic drug can be taken before a medical examination.
Conservative therapy
Methods of treating cough with purulent sputum depend on the nature of the underlying disease. However, given the undoubted involvement of bacterial microflora in the formation of pus, etiotropic therapy is prescribed to all patients. If necessary, bronchosanation is performed, the patient is trained in the method of postural drainage. Respiratory support is provided to patients with severe respiratory insufficiency. The following are the main groups of prescribed pharmacological drugs:
- Antibiotics. Antibacterial agents are used taking into account the sensitivity of microflora to them. Before receiving the test result, drugs are prescribed empirically. Preference is given to broad-spectrum antibiotics of the cephalosporin series, respiratory fluoroquinolones. Abscess, gangrene of the lungs are treated with drugs from the groups of carbapenems, lincosamides, tricyclic glycopeptides.
- Expectorants. They belong to pathogenetic drugs. Expectorants are prescribed to improve the rheological properties of sputum. They help to drain the cavity formation, ensure the removal of pathological secretions in purulent bronchitis, thereby contributing to recovery. Mucolytics and mucoregulators are mainly prescribed.
- Bronchodilators. They are used for concomitant bronchoobstructive syndrome in patients with bronchitis, COPD, bronchiectatic disease. Beta-adrenomimetics and cholinolytics of both short and prolonged action are prescribed. The drugs can be used in the form of a dosed aerosol and in a solution for nebulizer therapy.
Infusions of crystalloid solutions are prescribed to severe patients with severe intoxication, tumor decay syndrome. If necessary, glucocorticosteroid hormones, anti-tuberculosis drugs are used. Nonsteroidal anti-inflammatory drugs are used to stop the temperature reaction. Cancer patients are provided with adequate anesthesia.
Surgical treatment
Indications for surgical intervention are suppurated cavities of respiratory organs. Localized bronchiectasis can be treated surgically. Gangrene, lung abscesses, especially multiple, suppurated cysts are subject to surgical removal. The amount of intervention depends on the prevalence of the pathological process.
