Sputum viscosity is a symptom of chronic diseases of the lower respiratory tract, which include bronchitis, congestive pneumonia, bronchial asthma, chronic obstructive pulmonary disease (COPD). Sputum viscosity is characteristic of tuberculosis, cystic fibrosis, congenital and acquired bronchiectasis. To diagnose the cause of the discharge of thick sputum, X-ray examinations (CT, X-ray, bronchography), endoscopic and functional methods are prescribed. Sputum analysis and standard blood tests are mandatory. Mucolytics, anti-inflammatory, secretomotor agents, bronchodilators, antibiotics are used for treatment.
Causes of sputum viscosity
Chronic bronchitis
Sputum viscosity is typical for exacerbations of bronchitis, when the patient is worried about a wet cough and a slight deterioration of the condition. Up to 100 ml of cloudy thick mucus is released per day. Coughing up bronchial secretions is preceded by soreness in the chest, shortness of breath. A coughing attack is caused by inhaling smoke, pungent odors, but often there are no provoking factors.
With such a clinical picture, catarrhal bronchitis usually occurs. When an obstructive component is attached, shortness of breath occurs, painful coughing attacks, culminating in the release of a small amount of thick mucus. If purulent bronchitis develops, veins of pus appear in the coughed-up sputum viscosity, and with severe exacerbations it becomes profuse purulent.
Bronchial asthma
The discharge of thick vitreous sputum is a pathognomonic sign of an asthmatic attack. Initially, there is an attack of suffocation and dry cough. Gradually, breathing is restored (independently or after inhalation through a nebulizer), a wet cough appears, during which a scanty transparent mucus is separated. Often, the patient experiences difficulties with coughing up sputum viscosity, worries about the feeling that it is stuck in the airways.
The separated mucus indicates the end of an attack of bronchial asthma, soon the patient’s condition improves. If shortness of breath increases and sputum does not clear up, they talk about an asthmatic status requiring urgent medical care. Paroxysms of suffocation are provoked by physical exertion, psycho-emotional stress, contact with allergens – flower pollen, animal hair.
Chronic obstructive pulmonary disease
Coughing attacks with thick sputum occur with mild and moderate course of the disease. At this stage, patients are occasionally disturbed by cough, which is accompanied by expectoration of scanty thick cloudy mucus. During the day, sputum is released in a volume not exceeding 60 ml. During the exacerbation of COPD, mucus departs in greater quantities and liquefies, acquires a yellow-green color, an unpleasant odor.
Congestive pneumonia
In this disease, a cough develops with the release of viscous mucosa or mucopurulent sputum. Stagnant pneumonia is mainly detected in patients who observe bed rest for health reasons, as a result of which mucus expectorates more difficult. Usually sputum accumulates in the throat and in the oral cavity, a person cannot get rid of it. Weakness and shortness of breath are increasing.
Laryngitis and tracheitis
The appearance of thick sputum is characteristic of the chronic course of laryngotracheitis. At first, after coughing, liquid mucus is expectorated, but after 2-3 weeks, if treatment is ineffective, it becomes viscous, the amount of discharge decreases. Sputum accumulated in the area of the vocal folds leads to voice disorders, a person feels difficulty breathing. When trying to cough up, cloudy mucus leaves in a meager amount.
Inflammation of the upper respiratory tract
With chronic rhinitis and sinusitis, there is a syndrome of postnasal mucus leakage. Secretions spread along the back wall of the pharynx and cause a coughing attack with viscous mucus of a mucous or purulent nature. Coughing paroxysms often begin in the morning immediately after waking up or with prolonged lying down. Symptoms are more common in children.
Tuberculosis
When infected with Koch’s bacillus, coughing prevails with the release of thick, scanty sputum. Symptoms last for several months. There is a gradual increase in cough, an increase in the amount of viscous mucus being separated. In addition to respiratory symptoms, causeless weakness and fatigue, night sweats are worrying. The exacerbation of tuberculosis is indicated by a strong cough, accompanied by chest pain and expectoration of viscous mucosal sputum.
Cystic fibrosis
Clinical manifestations manifest in early childhood. In the pulmonary form of cystic fibrosis, paroxysms of painful cough with thick mucopurulent sputum attract attention. Due to congenital disorders of the biochemical composition, mucus is very viscous, so it accumulates in the bronchi, causing prolonged bronchitis and bilateral pneumonia.
Blockage of the bronchial tree with thick sputum leads to breathing difficulties, mixed shortness of breath. After a coughing attack and expectoration of secretions, the condition improves. With prolonged cystic fibrosis, in addition to coughing attacks with thick mucus, symptoms of respiratory and heart failure are observed. Children often get sick, lag behind in physical development.
Bronchiectatic disease
In patients with bronchiectasis, there is a discharge of copious thick sputum, which has a purulent character and a fetid smell. The symptom is especially pronounced in the morning: after a coughing attack, sputum is released by a “full mouth” in an amount of 50-100 ml or more. During the day, a cough constantly occurs, combined with expectoration of thick pus. When blood vessels rupture due to severe coughing paroxysms, blood inclusions are visible in the sputum viscosity.
Diagnostics
A patient complaining of sputum viscosity undergoes a comprehensive examination by a pulmonologist. Valuable information is provided by physical examination methods: palpation (chest soreness), percussion (local areas of dullness, box sound), auscultation (wet wheezing of different caliber, weakened breathing, bronchophony). The diagnostic plan includes the following laboratory and instrumental methods:
- Radiography. A standard chest X-ray is performed to detect local pathology – foci of infiltration or disintegration of lung tissue, signs of developmental abnormalities. Additionally, an X-ray is performed. In order to examine in detail the structure of the chest organs, a computed tomography is necessary.
- Spirometry. The study of the function of external respiration shows a decrease in FEV1, signs of respiratory disorders of an obstructive or restrictive type. To differentiate between COPD and bronchial asthma, a salbutamol test is performed, the results of which assess the degree of reversibility of obstruction.
- Invasive research. Bronchoscopy is performed to examine the inner surface of the bronchi, identify signs of the inflammatory process, and collect mucus samples. To assess the structure of the bronchial tree, to diagnose chronic bronchitis and bronchiectasis, bronchography with a contrast agent is performed.
- Sputum analysis. Under microscopy, mucus contains a large number of neutrophils (for infectious inflammation), Charcot-Leiden crystals and Kurschmann spirals (for bronchial asthma). To clarify the etiology of the pathological process, bacteriological sowing of the resulting secret is performed.
- Additional laboratory methods. Typical deviations in the hemogram: leukocytosis with a shift to the left in bacterial infection, lymphocytosis in viral pathogens, eosinophilia – in allergic lung diseases. In the biochemistry of blood, acute phase indicators, the level of IgE are determined. Sometimes an extended immunogram is prescribed.
Treatment
Help before diagnosis
To improve the discharge of sputum viscosity, the method of postural drainage is used: patting and tapping on the chest, being in a position with the head end lowered. Dosed physical activity is recommended for patients in a satisfactory condition. Special breathing exercises work effectively. The discharge of thick sputum is a symptom of serious diseases, therefore it is necessary to consult a doctor.
Conservative therapy
The main drugs for the elimination of sputum viscosity are mucolytics. Medications consist of proteolytic enzymes and other active substances that dilute bronchial mucus, improve expectoration, eliminate congestion. To increase the effectiveness of mucolytics, they are combined with secretomotor medications that increase the volume of mucous secretions and accelerate their excretion. With an etiopathogenetic purpose , therapy is also used:
- Antibiotics. They are prescribed for prolonged pneumonia, aggravated chronic bronchitis and bronchiectatic disease. They are selected taking into account the antibioticogram. In the tuberculosis treatment regimen, as a rule, a combination of 3-4 drugs intended for long-term use is selected.
- Bronchodilators. Medications from the group of beta-2-agonists and M-cholinolytics expand the lumen of the respiratory tract, improve the excretion of sputum viscosity. They eliminate the phenomena of shortness of breath and obstruction, are effective for emergency care in case of an attack of suffocation.
- Anti-inflammatory drugs. Mild forms of lung diseases respond well to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). Inhaled corticosteroids are also used, which relieve swelling of the bronchi, reduce mucus production. Those suffering from bronchial asthma are prescribed sodium cromoglycate for long-term therapy.
- Anti-allergic agents. Tablet forms are used: antihistamines, leukotriene receptor inhibitors. In case of atopic bronchial asthma, allergen-specific immunotherapy is performed during the remission period.
Physiotherapy techniques are effective for diluting sputum viscosity: inhalations with alkaline solutions and medications, vibratory chest massage, electrophoresis. Patients are recommended physical therapy classes, regular breathing exercises. For chronic respiratory diseases, courses of speleotherapy, spa treatment are indicated.
Surgical treatment
In the severe course of chronic bronchitis, bronchiectasis, invasive treatment methods are used: sanation bronchoscopy, bronchoalveolar lavage. With congenital defects of the respiratory system, limited forms of bronchiectatic disease, surgical intervention is recommended. Resection of the affected segments of the lung or removal of the whole lobe (lobectomy) is performed.
