Purulent Sputum : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 23/07/2022

Purulent sputum is a pathological discharge of the bronchi and trachea containing a large number of leukocytes, colored yellow, yellow-green or green. This symptom accompanies severe inflammation of the bronchial wall, observed in suppurative and neoplastic processes of the lung parenchyma and pleura. To establish the cause of coughing up purulent sputum, imaging and endoscopic diagnostic methods, as well as laboratory tests, are used. The choice of treatment tactics depends on the underlying disease.

Causes of purulent sputum

Purulent bronchitis

The discharge of a secret with an admixture of pus is often observed with an infectious lesion of the mucous membranes of the tracheobronchial tree. Purulent sputum in a patient with acute bronchitis indicates the addition of bacterial microflora. The disease takes on a protracted course. Dry or unproductive cough with a small amount of viscous mucus is replaced by a wet one. The sputum becomes semi-liquid.

In the mucus discharged with purulent bronchitis, purulent lumps appear, or the sputum is completely painted green. Cough is usually accompanied by intoxication and broncho-obstructive syndromes. In patients with chronic bronchitis, purulent sputum can be coughed up daily, during an exacerbation of the disease, the amount of discharge increases.


A common cause of purulent secretion with a cough is the presence of pathological segmental dilatations of the bronchi - bronchiectasis. Such formations can be congenital or develop against the background of malformations of the respiratory system. In bronchiectasis, mucus stagnates. The sputum becomes infected and becomes purulent. Formed bronchiectasis, which usually manifests itself in childhood.

The disease is manifested by a constant cough in the morning. The sputum is usually purulent and is coughed up profusely. During an exacerbation, the volume of discharge increases and often reaches 40 ml, body temperature rises, general weakness appears, and appetite decreases. Bronchiectasis is often complicated by hemoptysis. As the pathology progresses, shortness of breath increases, symptoms of chronic pulmonary heart appear.

The appearance of pus in the bronchial secretion in adults is often due to the formation of secondary bronchiectasis against the background of chronic bronchopulmonary pathology. The most common cause of these complications is COPD. The disease is characterized by slowly increasing shortness of breath, cough. With an exacerbation, purulent sputum leaves, there are signs of intoxication. Bronchiectasis aggravates the course of this pathology and worsens the prognosis.

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lung abscess

In large quantities, purulent sputum is coughed up during destructive diseases of the pulmonary parenchyma. Lung abscess is more often observed in patients with reduced immunity, in persons suffering from alcohol or drug addiction, as well as with aspiration of oral secretions and vomit. As a result of the activity of anaerobic bacteria or microbial associations, local purulent fusion of the lung tissue occurs.

The abscess is more often localized in the upper lobe of the right lung. At the first stage of the development of the disease, the cough is unproductive, viscous mucus leaves. There are pains on the affected side of the chest, febrile and hyperthermic fever, severe weakness. With good drainage of the abscess into the bronchus, the discharge becomes abundant and often fetid. Purulent green sputum leaves with a "full mouth", after which the state of health improves.

The disease acquires a chronic course with poor drainage of the focus of abscess formation, inadequate antibiotic therapy, and impaired functions of the patient's immune system. During remission, mucopurulent sputum is coughed up, exacerbation is accompanied by an increase in the volume of pathological secretions. The discharge acquires a green tint, a putrid odor appears.

Gangrene of the lung

Widespread purulent destruction captures a lobe or entire lung. It develops in immunocompromised individuals, people with alcoholism, drug addiction. It is extremely severe with high mortality. Intoxication is pronounced. Gangrene of the lung is characterized by a constant debilitating fever or a hectic type of temperature rise. Periods of apparent improvement are replaced by a sharp deterioration, indicating the spread of necrosis.

The sputum is purulent, with a pronounced stench. After an attack of painful coughing, a copious brown-green or dirty-gray discharge is expectorated. Its volume can be 100 ml or more. With the addition of parenchymal bleeding, sputum comes out in the form of raspberry-colored mucus. A purulent semi-liquid mass, isolated by patients with an abscess or gangrene of the lungs, forms 3 layers upon standing.

Bronchopulmonary carcinoma

In patients suffering from cancer of the lungs and bronchi, purulent sputum is coughed up in the phase of tumor decay. This process is observed in the terminal stage of the disease, or against the background of radiation or chemotherapy. Abundant discharge of pus with an unpleasant odor is accompanied by a sharp aggravation of the patient's condition due to the release of toxic decay products into the body.

Other reasons

Suppuration of the mucus secreted by the bronchial glands is possible if there is a cavity formation of any etiology drained by the bronchus in the lungs as a result of infection with a bacterial microflora. Purulent sputum is abundantly separated when the pleural empyema breaks into the respiratory tract. Other reasons for coughing up such a pathological secret include:

  • Specific infections: fibrous-cavernous tuberculosis.
  • Pulmonary mycoses: actinomycosis.
  • Festering cysts.


Diagnostic search for the causes of expectoration of pus or fetid mucus with a large number of yellow-green inclusions is carried out by pulmonologists. When collecting an anamnesis, the prescription of the disease and the treatment performed are specified. On examination, signs of acute or chronic respiratory failure are revealed. It is possible to finally establish why the patient coughs up purulent sputum using the following diagnostic measures:

  • Physical research. Percussion is determined by the dullness of the sound in the projection of the compaction of the lung tissue. Auscultatory with bronchitis against the background of hard breathing, dry whistling and buzzing rales are heard. In the presence of gangrene or abscess, breathing in the infiltration zone becomes bronchial, wet crepitating, medium and fine bubbling rales are detected.
  • visualization techniques. A plain chest radiograph shows infiltration zones with signs of destruction, thick-walled drained abscesses with a horizontal fluid level, and decaying tumors. With the help of bronchography, CT, MRI of the respiratory organs, bronchiectasis is visualized.
  • Endoscopic methods. Fibrobronchoscopy in some cases is a therapeutic and diagnostic manipulation. This method allows you to identify signs of purulent bronchitis, to obtain bronchial lavage for further research. If necessary, a biopsy of the suspicious area is performed. With the help of bronchoscopy, the tracheobronchial tree is sanitized.
  • Laboratory research. The suppurative process is accompanied by pronounced changes characteristic of inflammation in the peripheral blood. Purulent sputum, having settled, exfoliates with the formation of 2 or 3 layers. Microscopically, it reveals a significant number of leukocytes, pathological inclusions. Dietrich's plugs are determined with BEB, atypical cells - with tumors, elastic fibers are characteristic of abscess and gangrene.



Help before diagnosis

Purulent sputum is most often a sign of a serious, often life-threatening disease and requires immediate treatment in a medical facility. With a combination of this symptom with difficulty breathing, severe intoxication and other severe manifestations of the disease, an emergency medical attention is indicated. With concomitant fever, an antipyretic drug can be taken before a medical examination.

Conservative therapy

Treatment methods for cough with purulent sputum depend on the nature of the underlying disease. However, given the undoubted participation of bacterial microflora in the formation of pus, etiotropic therapy is prescribed for all patients. If necessary, bronchosanations are performed, the patient is trained in the method of postural drainage. Respiratory support is provided to patients with severe respiratory failure. Below are the main groups of prescribed pharmacological drugs:

  • Antibiotics. Antibacterial agents are used taking into account the sensitivity of microflora to them. Until the test result is obtained, drugs are prescribed empirically. Preference is given to broad-spectrum antibiotics of the cephalosporin series, respiratory fluoroquinolones. Abscess, pulmonary gangrene are treated with drugs from the groups of carbapenems, lincosamides, tricyclic glycopeptides.
  • Expectorants. Relate to drugs of pathogenetic action. Expectorants are prescribed to improve the rheological properties of sputum. They help to drain the abdominal formation, provide the removal of pathological secretions in case of purulent bronchitis, thereby contributing to recovery. Mucolytics and mucoregulators are mainly prescribed.
  • Bronchodilators. They are used for concomitant broncho-obstructive syndrome in patients with bronchitis, COPD, bronchiectasis. Beta-agonists and anticholinergics of both short and prolonged action are prescribed. The preparations can be used in the form of a metered-dose aerosol and in a solution for nebulizer therapy.

Serious patients with severe intoxication, tumor decay syndrome are prescribed infusions of crystalloid solutions. If necessary, glucocorticosteroid hormones, anti-tuberculosis drugs are used. To stop the temperature reaction, non-steroidal anti-inflammatory drugs are used. Cancer patients are provided with adequate pain relief.


Indications for surgical intervention are festering cavity formations of the respiratory organs. Surgical treatment can be used to treat localized bronchiectasis. Gangrene, lung abscesses, especially multiple, festering cysts are subject to prompt removal. The amount of intervention depends on the prevalence of the pathological process.

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