The Sputum Lexicon

Sputum is what we RTs are all about. We become RTs because we aren't afraid to suck it up. If you are an RT you've probably seen all of these at some point. If your an RT student, you'll become familiar with these soon enough.

Hey, if you're a lunger (COPD, asthma, bronchiectasis, cystic fibrosis), you also should be familiar with the various types of sputum. If you notice changes you should call your physician.

Sputum sample: A good sputum sample is of mucus from deep inside the lungs. You do not want it to be contaminated by mucus of the upper airway++.

Normal secretions*: Clear, thin, none, and with no odor

White*: May be first sign of a problem. May be normal with asthma.

Thick white*: May be sign of problem. May be normal with asthma. May also be sign of dehydration.

Light Yellow: May be sign of viral infection (especially if they have small grade or no fever). May be normal with COPD.

Yellow*: This can be a sign of an upper airway infection. May be normal variant with COPD. May be thick. May have an odor. (Bacterial infections may come with high grade fever)

Dark yellow or green*: Sign of worsening lung infection (bacterial).

Brown: Sign of bacterial pneumonia. May also be a sign of aspiration pneumonia.

Bloody: Sign of pneumonia or tuberculosis (hemoptysis).

Pink Frothy: A sign of pulmonary edema and cardiac failure.

Cream colored*: This may also be thick and will probably have an odor. This is puss coming from the lungs, and may be a sign of an infectious disease.

Chunky and dark brown*: May be aspiration pneumonia, gangrenous lung, really bad lung infection.

Bad odor**: May be sign of anaerobic infection or bronchiectasis

Mucoid secretions***: Clear or white in color. Generally they are produced in response to inflammation, and are seen commonly during acute asthmatic attacks and in uncomplicated chronic bronchitis*.

Purulent secretions***: Dark yellow or green and are seen mainly in bacterial infections. They tend to be very viscous. If caused by anaerobic bacteria it can have a disagreeable (fetid) odor and terrible taste. Examples of where this might be seen: aspiration pneumonia, lung abscess, and bronchiectasis *. Likewise, when normally clear mucus comes into contact with pus it becomes purulent. Thus, the word purulent comes from the word "pus." The presence of eosinophils ,which may be increased during an asthma exacerbation or during the common cold, may make mucus appear purulent.

Mucopurulent secretions***: A mix of mucoid and purulent secretions. They tend to be light to medium yellow and less viscous than purulent. They probably represent either the early or late (resolution) stage of an infection process.*

Antibiotics: These are only indicated if the sputum or nasal discharge color change is caused by an infection. Usually, an infection is indicated by purulent secretions. However, recent studies show purulent secretions only indicate a bacterial infection 31% of the time+++.

++Note: It must be noted here that green or yellow nasal secretions may indicate an infection in the nasal passages and not necessarily a lung infection. This is why the best sputum sample is one that bypasses the upper airway.

+++Anahad O'Connor, a NYTimes.com blogger, recently wrote a great post about this I will link to here.

*Nursinghomesabuseblog.com
**familypracticenotebook.com
***"Egan's Fundamentals of Respiratory Care, 6th Edition, 1995)