Fetid Sputum : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 02/08/2022

Fetid sputum occurs during destructive processes (abscess, gangrene), aspiration and Friedlander pneumonia, lung cancer. Less commonly, a symptom develops against the background of bronchiectasis, pleural empyema with bronchial fistula. X-ray and endoscopic imaging methods are used to diagnose the causes of foul-smelling sputum. From laboratory studies, microscopy and bacterial culture of the discharge, clinical and biochemical blood tests are prescribed. Treatment includes antibacterial drugs, bronchodilators, detoxification therapy. According to the indications, a pleural puncture or lung resection is performed.

Causes of fetid sputum

lung abscess

In the acute course of the pathology, expectoration of large amounts of purulent sputum with a fetid odor occurs. An unpleasant odor is caused by the breakdown of protein compounds as a result of prolonged stagnation of exudate in the abscess cavity. Sputum begins to be coughed up suddenly, "with a full mouth", its amount reaches 1 liter. The stench when an abscess breaks into the bronchus is so strong that it can be felt several meters from the patient.

In chronic lung abscess, there is periodic expectoration of fetid pus and mucus in small quantities. During the period of exacerbation, the volume of fetid sputum increases to 300-50 ml per day. There is a febrile fever, weakness, chills. Patients complain of pain in one half of the chest, shortness of breath on exertion, night sweats.

Gangrene of the lung

With extensive destruction of the lung tissue, dirty-gray putrefactive sputum appears. It has a pungent odor, coughs up in large volumes - 500-100 ml per day. If the blood vessels are damaged in the expectorant secretion, there are blood impurities. Pulmonary gangrene is characterized by the discharge of fetid sputum with a full mouth after a coughing fit. Symptoms are accompanied by dull pain in the chest, hectic fever and impaired consciousness.

Aspiration pneumonia

The disease usually proceeds insidiously. In the beginning, when coughing, a meager amount of mucus, mixed with pus, is excreted, which smells unpleasant. As aspiration pneumonia progresses, the amount of discharge increases. Sputum gradually acquires a putrid character, its smell becomes even more fetid, sharp. Often hemoptysis begins, with the destruction of large vessels - pulmonary bleeding. Patients are concerned about chest pain, febrile fever, chills.

Fetid sputum


Friedlander's pneumonia

For this type of pneumonia, the appearance of brown, fetid sputum with scarlet blood streaks is pathognomonic. Gradually, the amount of pus increases in the discharge. With Friedlander's pneumonia, sputum acquires a characteristic smell of burnt meat, which distinguishes the pathology from other types of lung damage. Patients are exhausted by a painful paroxysmal cough, there are difficulty in breathing, interruptions in the work of the heart.


If the disease is complicated by infection with anaerobic flora, the typical purulent sputum is replaced by putrid, the stench becomes more noticeable. Patients expectorate large amounts of greyish-green pus after a cough paroxysm. Fetid mucus is profusely discharged in the morning after waking up. The clinical picture with bronchiectasis is complemented by shortness of breath, pain in the chest.

Pleural empyema

Fetid sputum is expectorated when the inflammatory process is complicated by a bronchial fistula. In this case, the purulent exudate accumulated in the pleural cavity is drained through the respiratory tract when coughing. Expectorant sputum has a fetid odor, a dirty green color. When coughing, patients experience severe pain in the affected part of the chest. With empyema of the pleura, a typically forced position: half-sitting with an emphasis on the hands placed behind the body.

Lung cancer

With the decay of a malignant tumor, a painful cough occurs with expectoration of fetid brown, dirty green or gray sputum. The discharge has a heterogeneous structure, sometimes reddish particles of destroyed lung tissues are visible in it. Symptoms are more typical for peripheral lung cancer, while with the central location of the tumor, bleeding often opens, atelectasis of the affected lobe or segment develops.


With fetid atrophic rhinitis, thick, bloody-purulent discharges form from the nose, but they can drain down the back of the throat, causing a cough with sputum. A noticeable putrid odor constantly emanates from the patient, which is not associated with a cough attack or blowing the nose. Ozen usually damages the olfactory receptors, so the patient himself does not feel the stench. Patients are concerned about dryness and painful itching in the nose, nasal breathing disorders.


With complaints of fetid sputum, an examination by a pulmonologist is indicated. During a physical examination, the specialist evaluates the nature and frequency of breathing, performs percussion and auscultation of the lungs in order to make a preliminary diagnosis. If destructive processes in the lungs are suspected, a surgeon's consultation is required. The plan for diagnosing diseases manifested by sputum with an unpleasant odor includes the following methods:

  • X-ray imaging. Recommended X-ray of the chest in 2 projections, which shows rounded shadows with a horizontal level of fluid, areas of infiltration or decay, contours of volumetric formations. To clarify the diagnosis, MSCT is prescribed, which allows you to visualize pathological changes in detail.
  • Bronchoscopy. When examining the bronchi with an endoscope, signs of diffuse purulent endobronchitis are mainly found. If fetid sputum is caused by an oncological process, during bronchoscopy, the doctor sees a decaying tumor that clogs the bronchus. During the study, biopsy specimens are taken from suspicious areas.
  • Sputum analysis. When defending the biomaterial, a division into 3 layers is found (purulent, mucous and foamy). On visual inspection, you can see particles of the lung parenchyma, foreign bodies, pathogenic fungi. Foul-smelling sputum culture is carried out to isolate the infectious agent and perform an antibiotic sensitivity test.
  • Additional laboratory research . Changes specific to inflammation are found in the hemogram: increased ESR, neutrophilic leukocytosis. A biochemical blood test reveals dysproteinemia, an increase in acute phase parameters. To assess respiratory failure, blood gases are analyzed.

If the symptoms of pleurisy are determined, a therapeutic and diagnostic puncture of the pleural cavity, exudate sampling for bacteriological examination is necessary. Patients with chronic bronchopulmonary diseases to study the work of the heart perform ECG and echocardiography, since such pathologies are often combined with hemodynamic disorders. In difficult cases resort to angiopulmonography, diagnostic thoracoscopy.

Lung abscess - the cause of fetid sputum



Help before diagnosis

Cough with fetid sputum occurs with severe lesions of the bronchopulmonary system that cannot be treated at home. If you have such a symptom, you should consult a doctor as soon as possible. If the symptom is accompanied by impaired consciousness, hemoptysis or pulmonary hemorrhage, hectic fever, the patient needs urgent medical attention.

Conservative therapy

Most diseases that present with foul-smelling sputum are caused by bacterial infections. Therefore, etiotropic antimicrobial therapy is selected with the inclusion of drugs in the therapeutic regimen based on the results of the antibiogram. Combinations of 2-3 drugs are recommended, which are administered parenterally or locally (into the pleural cavity). Long-term antibiotic therapy is required - at least 10-14 days.

To improve sputum discharge, inhalations with brocholytics, proteolytic enzymes are used. To remove toxic products from the blood, detoxification methods are indicated: the introduction of electrolyte solutions in combination with diuretics, plasmapheresis, the use of desensitizing agents. To improve the rheological properties of blood, anticoagulants and antiplatelet agents are prescribed.

With a satisfactory and moderate condition of the patient, it is possible to perform percussion or vibration massage of the chest, which enhances the drainage function of the bronchi and stimulates the expectoration of fetid sputum. After the acute process subsides, physiotherapy is effective: ultrasound, speleotherapy, magnetotherapy. Patients are selected complexes of respiratory gymnastics and exercise therapy.


Massive purulent-destructive pulmonary lesions require surgical intervention. The volume of treatment is determined taking into account the prevalence of injuries: from segmentectomy or lobectomy of the lung to total pneumonectomy. For cancerous tumors, an extended operation is indicated with the removal of adjacent groups of lymph nodes. When the pleura is involved in the process, surgeons perform thoracostomy, pleurectomy with decortication of the lung.

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