What Are the Most Common Causes of Morning Phlegm?

Purulent sputum is one of the most common symptoms of respiratory diseases. It usually indicates inflammation in the respiratory system, especially the bronchus and lungs. It is often accompanied by cough, fever, and shortness of breath. The amount, color, smell, traits, and accompanying symptoms of pus and sputum can often prompt a diagnosis. Treatment should find the primary pathogenesis of pus and sputum, and treat the cause.

Basic Information

English name

purulent sputum

Visiting department

Respiratory Medicine

Common causes

Caused by bronchitis, bronchial pneumonia or pneumonia, lung abscess, bronchiectasis, etc., or acute, chronic pharyngitis, or purulent tonsillitis

Common symptoms

Thick sputum, often accompanied by cough, fever, shortness of breath, etc.

Causes of sputum and common diseases

Sputum is usually caused by bronchitis, bronchial pneumonia or pneumonia, lung abscess, bronchiectasis and other diseases. It is also common in acute, chronic pharyngitis or purulent tonsillitis.

Differential diagnosis of purulent sputum

Trait

(1) Mucus sputum: The sputum is thick, colorless and transparent or slightly white. It is more common in the early stages of bronchitis, bronchial asthma, pneumococcal pneumonia, and also found in chronic bronchitis, tuberculosis, and so on.

(2) Mucopurulent sputum: The characteristics of sputum are between mucous sputum and purulent sputum. There is a part of pus except mucus in the sputum, which is yellowish white and rich in viscosity; it is common in bronchitis, tuberculosis, and inflammation in the lung Wait. It is due to the formation of pus in the lung tissue during inflammation, and at the same time a large number of mucus secretions are mixed.

(3) purulent sputum: sputum is purulent, yellow or green, thick and sticky, and some have odor, common in purulent bronchitis, bronchiectasis, lung abscess, empyema or liver, spine, mediastinal abscess Bronchial fistula caused by piercing the lungs, etc., with odorous purulent sputum, often suggesting anaerobic infection.

2. Sputum volume

Diseases with a large amount of sputum include pulmonary edema, lung abscess, bronchiectasis, alveolar cell carcinoma, empyema or liver abscess formation of bronchial fistula. Examination of sputum volume is generally based on 24 hours. Increased sputum volume reflects the progress of inflammation of the bronchi and lungs; if sputum cannot be discharged smoothly, clinical manifestations are reduced sputum volume. In fact, the condition is still developing and the symptoms of poisoning will also increase.

3. Odor

General sputum has no odor. When it is left for a long time, it produces odor due to the decomposition of bacteria in the sputum. When the anaerobic bacteria are infected, the sputum has a foul odor. It is found in lung abscesses, bronchiectasis, and advanced lung cancer.

4. Color

Rust-colored sputum is characteristic of typical pneumococcal pneumonia; yellow-green or emerald-green sputum indicates Pseudomonas aeruginosa infection; sputum is thick and white and difficult to cough when pulled into filaments, suggesting a fungal infection; a large amount of thin serous sputum contains Powdery skin-like substances suggesting echinococcus disease (hydatid disease); pink foamy sputum is characteristic of pulmonary edema. If the cough is hundreds to thousands of milliliters of serous foamy sputum, the possibility of alveolar cancer also needs to be considered.

Sputum examination

Physical examination

In chronic tuberculosis and atelectasis, the trachea can be moved to the affected side. Swollen lymph nodes in the clavicle indicate primary bronchial cancer; dull dullness in the apex of the lung should pay attention to pulmonary tuberculosis; dull dullness in the lower chest should be considered for pulmonary inflammation or pleural effusion. Localized snoring sounds in any part of the lungs suggest inflammation or cavitation in the lungs; localized fine wet snoring sounds in the upper lungs indicate tuberculosis; moderate wet snoring sounds in the confined field to consider bronchiectasis; scattered wheezing sounds on both sides suggest bronchial asthma ; Bilateral scattered dry and wet rales suggest chronic bronchitis.

2. Laboratory inspection

(1) Microscopic examination: first observe with the naked eye, select suspicious parts, such as purulent cheese-like or granular sputum, and have a high positive rate of smear microscopy.

1) Squamous epithelial cells: Round, columnar, or squamous epithelial cells can be seen in sputum, and generally have no special significance. A large number of deformed and necrotic columnar epithelial cells and goblet cells can be seen in sputum of chronic bronchitis.

2) White blood cells: The sputum contains several white blood cells that are generally not of special significance, or indicate mild inflammation. When there are a large number of pus cells, it indicates purulent inflammation of the respiratory system.

3) Eosinophils: A large number of eosinophils are found in sputum, which is found in bronchial asthma, parasitic disease, etc.

4) Red blood cells: suggesting respiratory bleeding, seen in tuberculosis. Bronchiectasis.

5) Pigment cells: Macrophages are called pigment cells after phagocytosing pigment granules, and phagocytosis of hemosiderin is found in patients with idiopathic pulmonary hemosiderin, heart dysfunction and pulmonary congestion. Seen in all kinds of pneumoconiosis or those who inhale more smoke.

6) Cancer cells: The detection of cancer cells in the sputum of lung cancer patients has diagnostic significance.

7) Bacteria: Gram staining can identify cocci, bacilli, and acid-fast staining can find acid-fast bacilli.

8) Parasites: Pneumococcal eggs can be found in the sputum of patients with pneumococcal Wechnerella, and the heads and hooks of the echinococcus encapsulating worms can be found in the sputum of patients with pneumococcal wounds. Amoeba trophozoites can be found in the sputum of the abscess.

9) Actinomycetes: The sputum of patients with pulmonary actinomycetes can have yellow particles of the size of sesame, that is, sulfur particles. When the small sulfur particles are crushed and microscopically examined, a linear arrangement can be seen in the center. Fungal mycelia, whose ends are swollen and stick-shaped.

10) Sharp prisms: colorless and transparent octahedral crystals with different ends and different sizes. They are from eosinophils and can be found in bronchial asthma and pulmonary fluke disease.

(2) Bacterial culture: identify pathogenic bacteria and perform drug sensitivity tests at the same time to guide the clinical rational choice of antibiotics.

3. Instrument inspection

(1) X examination: It is an important diagnostic method for heart and lung diseases. Large inflammatory shadows in the lungs are mostly inflammation of the lungs; if the symptoms of chest pain, rush, and shock are obvious, the shadows are fan-shaped, and the base is facing the pleura, the pulmonary infarction should be excluded. Infiltrative shadows in the upper lungs first consider invasive pulmonary tuberculosis. Pulmonary shadows, lung swelling, lung cancer, and tuberculosis. Diffuse shadows in the lung should be considered miliary tuberculosis, alveolar cell carcinoma, hemosiderin, silicosis, and lung metastatic cancer. For suspected bronchiectasis, bronchial lipiodol imaging can be performed to determine the diagnosis and treatment plan.

(2) CT examination: It can distinguish the lung structure that cannot be displayed in ordinary X-rays, and the percutaneous lung biopsy guided by CT is accurate and safe.

(3) Fiber bronchoscopy: Fiber bronchoscopy should be performed on patients with suspected lung cancer to observe the lesions. Patients with lung infections use a double cannula to suck or brush the secretions of the bronchioles in the lungs under the fiber bronchus to make pathogens Cultivate to avoid oral contamination and high positive rate. Bronchial alveolar lavage may be performed when necessary to find the cause of lung disease and make a clear diagnosis.

Sputum treatment principles

According to the primary disease caused by purulent sputum, a clear diagnosis. Treatment for the cause.