Wet cough

Depending on the above reasons, a non-productive (dry) and productive (wet) cough are distinguished. Wet cough is characterized by separation of sputum. For some diseases, only an unproductive (dry) cough is typical, for others, especially inflammatory diseases of the respiratory system, is productive, usually replacing the unproductive. In a number of cases (for example, with acute laryngitis), after the productive cough phase, the phase of an unproductive cough is repeatedly noted, resulting from a decrease in the sensitivity threshold of cough receptors. In the latter case, the pathogenetically justified the appointment of non-expectorants, and antitussive agents.

Wet cough is diffuse sputum.

• Increased sputum formation is characteristic for inflammation of the bronchi (bacterial or viral infection), inflammatory lung infiltrate (pneumonia).
• Prolonged coughing, resulting in sputum, often very pronounced before bedtime and even more severe in the morning, after sleep, are characteristic of chronic bronchitis. Sometimes with such an attack of cough, there may be a loss of consciousness - syncopal condition, cough syncope.
• Sometimes the withdrawal of a large amount of sputum occurs simultaneously, "full mouth" (emptying the lung abscess, large and multiple bronchialectasis), especially in a particular position of the body.
• Chronic productive (wet) cough is observed with bronchoectatic disease. With unilateral bronchiectasis, patients prefer to sleep on the affected side in order to suppress the coughing that disturbs them. It is in this situation that the postural (position) drainage of the bronchi acquires the importance of the treatment procedure (increasing the sputum discharge by giving the patient a position in which it leaves the pope by gravity). In addition to the special position of the body, an elongated-forced exhalation is necessary, in which a high-speed air current is created that carries with it a bronchial secret.

Despite a strong cough push, the sputum can not be expectorated. This is usually due to its increased viscosity or arbitrary swallowing. Often, a minor cough and poor sputum is not considered a sign of the disease (for example, the usual morning cough with the smoker's bronchitis), so the doctor should himself focus on the patient's complaint on this complaint.

Examination of sputum

To establish the diagnosis of pulmonary disease, it is of great importance to study the properties of sputum secreted or obtained by special methods (aspiration of the contents of the bronchi during bronchoscopy).

[1], [2]

Properties of sputum

It is necessary to pay attention to the following properties of phlegm:

• quantity;
• consistency;
• appearance, color, smell;
• presence of impurities;
• stratification;
• take into account also the data obtained with a microscopic (including cytological) study.

The amount of sputum produced per day can fluctuate within large limits. Sometimes reaching 1-1.5 liters (for example, with large bronchiectasises, abscesses and tubercular lung cavities, cardiogenic and toxic pulmonary edema, emptying through the bronchus of the pleural cavity with purulent pleurisy, bronchorrhea, adenomatosis of the lungs).

Sputum for purulent-inflammatory diseases of the lungs can be liquid or viscous, depending on the amount of mucus in it. Most sputum is mucopurulent. Especially viscous sputum is observed in acute inflammatory diseases of the lungs, in the initial period of an attack of bronchial asthma. Less often sputum is liquid, or serous (predominance of proteinaceous transudate), for example, with pulmonary edema, alveolar-cell carcinoma.

Sputum on standing is divided into three layers: the top layer is frothy serous fluid, the middle layer is liquid, contains a lot of leukocytes, erythrocytes, bacteria (the most significant in volume), the lower layer is purulent (sputum microscopy reveals neutrophils, various kinds of bacteria). Such a three-layered sputum may have an unpleasant (putrefactive, fetid) odor, which is usually characteristic of anaerobic or combination of anaerobic and streptococcal infections, as well as for the disintegration of the lung tissue.

A bacterial infection is characterized by a yellowish-green color of sputum. Yellow color sputum sometimes gives a large number of eosinophils (allergies). With severe jaundice, sputum may resemble a light bile, and sputum gray and even black is sometimes observed in persons inhaling coal dust (miners).

In the presence of productive cough, it is necessary to obtain material from the trachea and bronchi (not saliva) for subsequent staining of it by Gram and microscopy.

Questions to ask if you have a productive cough

• How often does coughing up phlegm?
• What is the daily amount of sputum produced?
• How difficult is it that clearses phlegm?
• In what position does the body expect better cough?
• What color usually has phlegm?
• Are there any impurities (blood - scarlet or dark, dense particles).