Green Phlegm : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 01/08/2022

Green sputum occurs with lobar pneumonia, chronic bronchitis and bronchiectasis, tuberculosis. Less commonly, the cause of the symptom is pulmonary mycoses, cystic fibrosis, and oncological processes. Thick green sputum occurs in chronic sinusitis. For diagnostic purposes, instrumental (radiography, CT scan of the lungs, bronchoscopy) and laboratory techniques (microscopic and bacteriological examination of sputum, blood tests) are used. The treatment plan includes antibiotics, bronchodilators, expectorants. Sometimes oxygen support, surgical interventions are prescribed.

Causes of green sputum


Expectoration of green sputum is a typical symptom of segmental or croupous pneumonia. Purulent discharge with an unpleasant odor appears on the 2nd-4th day of the disease. The patient begins a painful attack of coughing, after which a moderate amount of sputum is secreted. Pneumonia is not characterized by the release of pus "full mouth", as with a destructive lung lesion.

Expectoration of sputum lasts 1-2 weeks. Gradually, the amount of green mucus decreases, the discharge becomes white-yellow, cloudy. In addition to this symptom, a person is concerned about dull soreness in the chest, aggravated by coughing. There is a febrile temperature, general malaise, shortness of breath. Patients avoid taking deep breaths to avoid exacerbating chest pain.

Chronical bronchitis

Green thick sputum is mainly separated from people who have been ill for 4-5 years or longer. Deformations are formed in the bronchi, which contribute to the stagnation of the mucous secretion and the reproduction of pathogenic microflora in it. For the chronic form of bronchitis, coughing up green mucus in the morning after sleep is typical. A person has a painful coughing attack, which ends with the release of sputum. During the day, the symptom rarely bothers.

During an exacerbation of bronchitis, the volume of green sputum increases to 200-30 ml per day. Patients complain of increased shortness of breath, weakness and malaise. Body temperature is elevated. The cough becomes constant, combined with expectoration of thick yellow-green or gray-green mucus, which has an unpleasant odor. The exacerbation lasts 2-3 weeks, after which the amount of green sputum decreases.


With this disease, secretion stagnates in the dilated and deformed bronchi, due to which it becomes infected with pathogenic bacteria. With exacerbations of the disease and coughing paroxysms, a large amount of green secretion with a fetid odor is released. Increased discharge of mucus occurs after being in a prone position with the head end lowered or after breathing exercises.

For the period of remission, scanty mucopurulent sputum of a green hue is typical, which is released by separate spitting during a cough attack. Chronic hypoxia is noted in those suffering from bronchiectasis, so patients complain of increased fatigue, dizziness, and deformity of the terminal phalanges of the fingers. If pathology occurs in children, a lag in physical development is usually detected.

green phlegm


Chronic sinusitis

In the paranasal sinuses, a thick green secret is formed, which often flows down the back of the throat, causing a cough reflex. A paroxysmal cough is more often observed in the morning, immediately after waking up, since a large amount of discharge has time to accumulate during the night. A person is concerned about pain and heaviness on the affected side of the face, headaches, aggravated by bending the torso forward.


A greenish tint of mucus is characteristic of an exacerbation of the disease and a massive lesion of the lung tissue, or for the addition of a secondary infection. With tuberculosis, the symptom appears against the background of an increase in body temperature, intense chest pain, and night sweats. Patients are concerned about paroxysmal paroxysms of coughing, accompanied by the release of scanty green sputum, which has an unpleasant odor.

cystic fibrosis

Symptoms of the disease are detected in childhood. A viscous secret is formed in the bronchi in large quantities, which is difficult to cough up. The patient produces sputum after a long, agonizing cough. The airways clear much better after being in a drainage position. The discharge is thick and viscous, has a green or gray-green tint, and may contain separate mucous lumps.

Often the pathology is complicated by bronchitis or pneumonia, the sputum becomes more liquid and acquires a yellow-green color. In addition to a wet cough, patients are concerned about shortness of breath, weakness, frequent inflammation of the upper respiratory tract (sinusitis, tonsillitis) with a specific clinical picture. With a mixed form of cystic fibrosis, digestive disorders are added.

Mycosis of the lungs

For fungal pneumonia, mucopurulent green sputum is typical, expectorated in a small amount. With aspergillosis, the discharge looks like dense, dirty green lumps mixed with mucus; with zygomycosis, the symptom is supplemented by hemoptysis or pulmonary bleeding. Fungal infections occur with severe intoxication. The extremely serious condition of patients is typical for a mixed form of pneumomycosis, concomitant immunodeficiency.

Malignant neoplasms

In bronchopulmonary cancer, the symptom occurs during the decay of the tumor. The sputum is copious, dirty green or grayish, and has a sharp, fetid odor. Often, brown particles of the lung parenchyma or streaks of blood can be seen in it. A similar clinical picture is observed in cancer of the lungs or small bronchi. Germination of the tumor with involvement in the process of the pleura is characterized by severe pain in the affected part of the chest.


A qualified pulmonologist should identify the etiological factors that led to the release of green sputum. During the examination, attention is paid to the symmetry of the participation of the chest in the act of breathing, signs of pulmonary insufficiency, and characteristic breath sounds are heard. Informative diagnosis of diseases is impossible without laboratory and instrumental methods:

  • X-ray examination. The roentgenogram of the chest in direct and lateral projection shows areas of inflammatory infiltration of the lung tissue, compaction zones, contours of neoplasms. CT of the lungs helps to visualize the structure of the organ in detail. Bronchography is used to detect signs of bronchial deformity.
  • FVD research. For the diagnosis of chronic bronchopulmonary diseases, spirometry is indicated, the results of which are used to judge the vital capacity of the lungs, the volume of forced exhalation and the degree of reversibility of changes. To quickly assess the function of external respiration, the method of peak flowmetry is used.
  • Bronchoscopy. Visualization of the bronchial tree by the endoscopic method is needed in case of difficulties in differential diagnosis, if a malignant process is suspected. The method shows the condition of the bronchial mucosa, allows you to detect deformations, neoplasia. If necessary, a biopsy is taken using a bronchoscope.
  • Sputum analysis. Microscopic examination of the biomaterial evaluates the content of blood cells, the presence of bacteria or fungal spores. Be sure to stain for acid-fast bacteria to exclude tuberculosis. Next, produce a bacteriological analysis of the discharge.

Additionally, a clinical and biochemical blood test is required, in which signs of an inflammatory process are found. To clarify the diagnosis, an MRI of the lungs is performed. To examine the surface of the lung tissue, diagnostic thoracoscopy is recommended. If green sputum is caused by an infection of the nasal cavity, an otolaryngologist's consultation is prescribed with rhinoscopy and radiography of the paranasal sinuses.

Inhalation therapy



Help before diagnosis

With the appearance of purulent green sputum, it is very important to ensure that the airways are cleared of the accumulated secret. Patients are advised to be in position for postural drainage several times a day, to do breathing exercises. You can not take antitussive drugs that aggravate the course of the disease. Green sputum occurs with serious infectious or chronic processes, so self-medication is unacceptable.

Conservative therapy

Non-severe forms of chronic pathology are treated on an outpatient basis. Diseases that cause green sputum often worsen the patient's condition, so hospitalization is required. If there are signs of respiratory failure, oxygen support is provided. Etiopathogenetic therapy includes the following groups of drugs:

  • Antibiotics . They are prescribed to destroy pathogenic microorganisms that cause the formation of purulent green sputum. Antimicrobial agents are selected taking into account the results of bakposev. For the treatment of tuberculosis, special antibiotics are used in combinations of 3-4 items.
  • Mucolytics . They liquefy sputum, thanks to which it is freely removed when coughing and does not stagnate in the bronchial tree. To enhance the effect, secretory agents are added that stimulate mucociliary clearance.
  • Bronchodilators . Effective in chronic diseases accompanied by difficulty breathing. The drugs expand the lumen of the bronchi, so it becomes easier for a person to breathe, and sputum freely leaves during a fit of coughing.

With the ineffectiveness of standard measures, they resort to bronchoalveolar lavage and aspiration of purulent secretions. During therapeutic bronchoscopy, intrabronchial administration of antibacterial drugs is possible. Of the physiotherapeutic methods, vibration massage of the chest, drug electrophoresis, and inhalations are actively recommended.


In case of bronchiectasis, the affected areas of the lung are removed - segmentectomy or lobectomy. In a complicated course of pneumonia with the development of destruction zones, their excision is performed. In destructive forms of tuberculosis, cavernectomy, thoracoplasty, and pleurectomy are indicated. For patients with lung cancer, surgery is the main method of treatment and is complemented by chemotherapy.

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