Viscous Sputum : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 16/07/2022

Viscous (thick) sputum is a symptom of chronic diseases of the lower respiratory tract, which include bronchitis, congestive pneumonia, bronchial asthma, chronic obstructive pulmonary disease (COPD). Viscous sputum is characteristic of tuberculosis, cystic fibrosis, congenital and acquired bronchiectasis. To diagnose the cause of thick sputum, x-ray studies (CT, fluoroscopy, bronchography), endoscopic and functional methods are prescribed. Sputum analysis, standard blood tests are required. For treatment, mucolytics, anti-inflammatory, secretory agents, bronchodilators, antibiotics are used.

Causes of viscous sputum

Chronical bronchitis

Viscous sputum is typical for exacerbations of bronchitis, when the patient is worried about a wet cough and a slight deterioration in the condition. Up to 10 ml of cloudy thick mucus is released per day. Coughing up bronchial secretion is preceded by soreness in the chest, shortness of breath. A coughing fit is caused by inhalation of smoke, pungent odors, but often there are no provoking factors.

With such a clinical picture, catarrhal bronchitis usually occurs. When an obstructive component is attached, shortness of breath occurs, painful bouts of coughing, culminating in the release of a small amount of thick mucus. If purulent bronchitis develops, streaks of pus appear in the coughed up viscous sputum, and in severe exacerbations it becomes profusely purulent.

Bronchial asthma

The discharge of thick glassy sputum is a pathognomonic sign of an asthmatic attack. Initially, there is an attack of suffocation and dry cough. Gradually, breathing is restored (on its own or after inhalation through a nebulizer), a wet cough appears, during which scanty clear mucus is separated. Often the patient has difficulty coughing up viscous sputum, worried about the feeling that it is stuck in the airways.

Separated mucus indicates the end of an asthma attack, soon the patient's condition improves. If shortness of breath increases and sputum is not coughed up, they speak of status asthmaticus, requiring emergency medical attention. Paroxysms of suffocation are provoked by physical exertion, psycho-emotional stress, contact with allergens - pollen, animal hair.

Chronic obstructive pulmonary disease

Cough attacks with thick sputum occur in mild to moderate disease. At this stage, patients are episodically worried about coughing, which is accompanied by expectoration of scanty, thick, cloudy mucus. During the day, sputum is excreted in a volume not exceeding 6 ml. During the exacerbation of COPD, the mucus leaves in a larger amount and liquefies, acquires a yellow-green color, and an unpleasant odor.

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congestive pneumonia

With this disease, a cough develops with the release of viscous mucous or mucopurulent sputum. Congestive pneumonia is mainly detected in patients who are on bed rest for health reasons, as a result of which mucus is more difficult to expectorate. Usually, phlegm accumulates in the throat and in the mouth, and a person cannot get rid of it. Growing weakness, shortness of breath.

Laryngitis and tracheitis

The appearance of thick sputum is characteristic of the chronic course of laryngotracheitis. First, after a cough, liquid mucus is expectorated, but after 2-3 weeks, if the treatment is ineffective, it becomes viscous, the amount of discharge decreases. Phlegm that has accumulated in the area of ​​the vocal folds leads to voice disorders, a person feels difficulty in breathing. When you try to cough up cloudy mucus in a meager amount.

Inflammation of the upper respiratory tract

In chronic rhinitis and sinusitis, a syndrome of postnasal mucus leakage is observed. The secretions spread along the back of the pharynx and cause a cough attack with viscous sputum of a mucous or purulent nature. Cough paroxysms often begin in the morning immediately after waking up or after a long stay in a supine position. Symptoms are more common in children.


When infected with a Koch stick, coughing predominates with the release of thick, scanty sputum. Symptoms last for several months. There is a gradual increase in cough, an increase in the amount of separated viscous mucus. In addition to respiratory symptoms, causeless weakness and fatigue, night sweats are of concern. An exacerbation of tuberculosis is evidenced by a strong cough, accompanied by pain in the chest and expectoration of viscous mucous sputum.

cystic fibrosis

Clinical manifestations manifest in early childhood. In the pulmonary form of cystic fibrosis, paroxysms of a painful cough with thick mucopurulent sputum attract attention. Due to congenital disorders of the biochemical composition, mucus is very viscous, therefore it accumulates in the bronchi, causing prolonged bronchitis and bilateral pneumonia.

Blockage of the bronchial tree with thick sputum leads to difficulty breathing, mixed shortness of breath. After a cough attack and expectoration of the secret, the condition improves. With long-term cystic fibrosis, in addition to coughing attacks with thick mucus, symptoms of respiratory and heart failure are observed. Children often get sick, lag behind in physical development.


In patients with bronchiectasis, there is a discharge of abundant thick sputum, which has a purulent character and a fetid odor. The symptom is especially pronounced in the morning: after an attack of coughing, sputum is released with a "full mouth" in the amount of 50-10 ml or more. During the day there is a constant cough, combined with expectoration of thick pus. When blood vessels rupture due to strong coughing paroxysms, blood inclusions are visible in viscous sputum.


A patient with complaints of viscous sputum undergoes a comprehensive examination by a pulmonologist. Valuable information is provided by physical examination methods: palpation (chest soreness), percussion (local areas of dullness, box sound), auscultation (wet rales of various calibers, weakened breathing, bronchophony). The diagnostic plan includes the following laboratory and instrumental methods:

  • Radiography. A standard X-ray of the chest is performed to detect local pathology - foci of infiltration or decay of the lung tissue, signs of developmental anomalies. Additionally, fluoroscopy is performed. Computed tomography is required to examine the structure of the chest organs in detail.
  • Spirometry. The study of the function of external respiration shows a decrease in FEV1, signs of respiratory disorders of an obstructive or restrictive type. To differentiate between COPD and bronchial asthma, a salbutamol test is performed, the results of which assess the degree of obstruction reversibility.
  • Invasive research. Bronchoscopy is performed to examine the inner surface of the bronchi, identify signs of an inflammatory process, and collect mucus samples. To assess the structure of the bronchial tree, to diagnose chronic bronchitis and bronchiectasis, do bronchography with a contrast agent.
  • Sputum analysis. Under microscopy, the mucus contains a large number of neutrophils (with infectious inflammation), Charcot-Leiden crystals and Kurshman's spirals (with bronchial asthma). To clarify the etiology of the pathological process, a bacteriological culture of the resulting secret is performed.
  • Additional laboratory methods. Typical abnormalities in the hemogram: leukocytosis with a left shift in bacterial infection, lymphocytosis in viral pathogens, eosinophilia in allergic lung diseases. In blood biochemistry, acute phase indicators, the level of IgE are determined. Sometimes an extended immunogram is prescribed.

On auscultation of the lungs, moist rales of various calibers are heard.



Help before diagnosis

To improve the discharge of viscous sputum, the method of postural drainage is used: patting and tapping on the chest, being in a position with the head end lowered. Patients in a satisfactory condition are recommended dosed physical activity. Special breathing exercises work effectively. Isolation of thick sputum is a symptom of serious illness, so you need to see a doctor.

Conservative therapy

The main drugs for eliminating viscous sputum are mucolytics. Medicines consist of proteolytic enzymes and other active substances that thin bronchial mucus, improve expectoration, and eliminate congestion. To increase the effectiveness of mucolytics, they are combined with secretory drugs that increase the volume of mucous secretions and accelerate their excretion. For etiopathogenetic purposes, the following are also used in therapy:

  • Antibiotics . They are prescribed for prolonged pneumonia, exacerbated chronic bronchitis and bronchiectasis. They are selected taking into account the antibiogram. In the treatment regimen for tuberculosis, as a rule, a combination of 3-4 drugs is selected, intended for long-term use.
  • Bronchodilators . Medications from the group of beta-2-agonists and M-anticholinergics expand the lumen of the respiratory tract, improve the excretion of viscous sputum. They eliminate the phenomena of shortness of breath and obstruction, are effective for providing emergency care for an asthma attack.
  • Anti-inflammatory drugs . Non-severe forms of pulmonary diseases respond well to treatment with non-steroidal anti-inflammatory drugs (NSAIDs). Inhaled corticosteroids are also used, which relieve swelling of the bronchi, reduce mucus production. Patients suffering from bronchial asthma for long-term therapy are prescribed sodium cromoglycate.
  • Antiallergic drugs . Tablet forms are used: antihistamines, leukotriene receptor inhibitors. In atopic bronchial asthma in remission, allergen-specific immunotherapy is performed.

To thin viscous sputum, physiotherapeutic methods are effective: inhalation with alkaline solutions and drugs, vibration chest massage, electrophoresis. Patients are recommended exercise therapy, regular breathing exercises. In chronic diseases of the respiratory organs, courses of speleotherapy, sanatorium treatment are indicated.


In severe chronic bronchitis, bronchiectasis, invasive treatment methods are used: sanitation bronchoscopy, bronchoalveolar lavage. With congenital malformations of the respiratory system, limited forms of bronchiectasis, surgical intervention is recommended. Resection of the affected segments of the lung or removal of an entire lobe (lobectomy) is performed.

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