Sputum is mucus that is coughed up from the lower airways. In medicine, sputum samples are usually used for naked eye exam, microbiological investigations of respiratory infections and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose. Naked eye exam of sputum can be done at home by a patient in order to note the various colors. Any hint of yellow color suggests an airway infection. Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot or a white sink surface. The more intense the yellow color, the more likely it is a bacterial infection.
Description
The best sputum samples contain very little saliva, as saliva contaminates the sample with oral bacteria. This is especially true for samples for lab testing in cytology or microbiology. Specimen adequacy is assessed by the laboratory technologists by examining a Gram stain or cytology stain of the sputum. More than 25 squamous epithelial cells at low power magnification exam with the microscope strongly suggests salivary contamination. Sputum samples have been used to quantify the degree of airway inflammation in human diseases such as asthma. Specifically, this work has demonstrated that a sub group of severe asthma patients have airway inflammation that is resistant to treatment with corticosteroids. When a sputum specimen is plated out in microbiology, it is best to get the portion of the sample that most looks like yellow pus onto the swab. If there is any blood in the sputum, this should also be on the swab. Microbiological sputum samples are used to look for infections, such as Moraxella catarrhalis, Mycobacterium tuberculosis, Streptococcus pneumoniae, and Haemophilus influenzae. Other pathogens can also be found. sputum contains pus, composed of white blood cells, cellular debris, dead tissue, serous fluid, and viscous liquid. Purulent sputum is typically yellow or green. It is seen in cases of bronchiectasis, lung abscess, or an advanced stage of bronchitis.
Interpretation
Sputum can be :
Bloody
* Blood-streaked sputum – inflammation of throat or bronchi; lung cancer; other bleeding erosions, ulcers, or tumors of the lower airway.
* Pink sputum – sputum evenly mixed with blood from alveoli and/or small peripheral bronchi.
* Massive blood – cavitary tuberculosis or tumor such as lung cancer, or lung abscess; bronchiectasis; lung infarction; pulmonary embolism.
Green or greenish colored - indicative of longstanding respiratory infection as in pneumonia, ruptured lung abscess, chronic infectious bronchitis, and infected bronchiectasis or cystic fibrosis.
Yellow, yellowish purulent – containing pus. "The sputum color of patients with acute cough and no underlying chronic lung disease does not imply therapeutic consequences such as prescription of antibiotics." The color can provide hints as to effective treatment in chronic bronchitis patients:
* A yellow-greenish color suggests that treatment with antibiotics can reduce symptoms. The green color is caused by degenerating neutrophil verdoperoxidase.
Whitish gray sputum color against a white color background tends to indicate either a specimen from someone who is dehydrated, and/or from an older person, and/or a specimen with a mixed, modest number of eosinophils and maybe some acute inflammatory neutrophil cells.
A white, milky, or opaque appearance means that antibiotics are less likely to be effective in treatment because the likelihood is greater of a viral infection or allergy than of antibiotic-responsive micro-organisms.
