How to Get Sputum Out of Lungs

Do you bring out sputum every morning? Do you feel the sputum builds up often in your lungs? Excess production of sputum can decrease the physical,mental and social well being for some people. Let us explore what sputum is and when you should worry about it.

What is sputum?

Sputum is nothing but mucus secreted by special cells lining the airways. Normally about 20-30 ml of secretions are produced every day. These secretions trap the inhaled foreign particles, and chemicals and fight against germs trapped in them.¹ This mucus is constantly cleared by the cells lining the airways by moving it upwards. Coughing is another method for clearing mucus secretions.² 

Causes of having sputum 

The efficient clearing of the mucus is paramount for a healthy lung and any impairment in the clearing mechanism almost always causes lung disease. In airway diseases like asthma and COPD (chronic obstructive pulmonary disease), the damage to the airways due to the disease process alters the mucus to make it thicker and more difficult to clear. In cystic fibrosis, the composition of the mucus is altered to make it more viscous (thick) and sticky. This abnormal mucus is called ‘sputum’ or ‘phlegm which can be clear, pale yellow or yellowish-green in colour.³ This sputum is produced in excess amounts in airway diseases, causing its accumulation, ultimately leading to infection and inflammation of the airways.This could result in irreversible damage to airways and lungs and a variety of long-term symptoms like breathlessness.

Effects of having sputum

The accumulation of excess mucus in the airways causes symptoms like:

1. Difficulty in breathing due to obstruction of the airway lumen
2. Cough
3. “Tickle in the throat” due to dripping of mucus from the nose 
4. Wheeze
5. Episodic worsening of asthma and COPD

Long-term accumulation of mucus in the airways can cause permanent structural and functional damage to the lungs, which could perpetuate the underlying disease process and reduce the quality of life.

Is sputum contagious?

Most of the germs that cause respiratory infections can spread from person to person via the droplets of sputum or by direct contact with the secretions.⁴ Coughing and sneezing produce tiny droplets that contain live organisms that can spread especially when people are crowded together and within family groups.

Direct contact occurs when the sputum that is sneezed or coughed out is not disposed of properly or when objects like bedsheets are contaminated with secretions. Healthcare workers and carers are especially exposed to the spread by direct contact.

However, it should be mentioned here that, whether the exposure to the sputum will cause disease or not, depends on a number of factors like the immunity of the person, the number of germs in the droplet, the virulence of the organism, etc.⁴

How to prevent having sputum

Sputum is a sign of unhealthy airways and can be prevented by avoiding the risk factors of the disease that causes it. In the case of asthma, avoiding triggers like allergens along with regular treatment and follow-up will help reduce the episodes of worsening symptoms. 

Avoiding stimulants of sputum production like exposure to environmental pollutants, aerosols from infected persons, active and passive smoke, timely vaccination and indoor dust particles can go a long way to prevent sputum production. 

In the case of genetic disorders like cystic fibrosis, sputum production cannot be avoided completely but there are many medications and devices available to improve airway hygiene.⁶ However, considering avoidable risk factors, a major factor to remember is smoking. 

COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung condition that includes chronic bronchitis and emphysema, mostly caused by smoking. COPD affects about 115,000 people annually in the UK -that’s a new diagnosis every five minutes.⁷ COPD causes nearly 30,000 deaths every year in the UK.8 People affected by COPD suffer from cough with phlegm production, breathlessness on exertion and frequent chest infections.About 40%-70% of COPD patients go on to develop lung cancer which is a common cause of death in this group.⁹ 

If you are living with COPD, there are local and online COPD support groups to receive and give support as well as charities to get information and share experiences. 

Quitting smoking is definitely a commendable change toward reducing sputum and having healthier lungs. If you are considering quitting smoking or cutting down, there are plenty of options to help you deal with addiction and withdrawal symptoms. In addition, local support groups like the Local Stop Smoking Service (LSSS) and charities like Ash and Quit aid your journey towards a smoke-free life.

How to get sputum out of the lungs

In chronic conditions like COPD and bronchiectasis, sputum needs to be brought out on a regular basis to prevent the worsening of the condition and developing infections. In bronchiectasis, an abnormal permanent dilatation of the airways occurs leading to failure of mucus clearance and production of copious amounts of thick phlegm.  

Bringing out the sputum can be done with a help of a physiotherapist by employing a few maneuvers.¹⁰

They are:

1. Clearance exercises 
2. Active Cycle of Breathing Techniques (ACBT): In this, a period of normal breathing is followed by deep breathing and coughing out the mucus, repeated in cycles.
3. Postural drainage, in this a series of postural changes is employed along with vibrating areas of the lung to facilitate sputum drainage.

In addition to this, there are a few devices that combine vibration and air pressure to help bring the phlegm out.

Medicines are also available to help break down the mucus in the secretions and clear the lungs. Sometimes, medicines are inhaled through machines called nebulisers, which comprise a mask or mouthpiece, a chamber where the medicine is converted to fine mist and a compressor to push medicine into the lungs.

Medicines to dilate the airways can be administered through inhaler devices and antibiotics may be prescribed by the GP for infections.

When to seek medical attention?

If you have more than usual secretions in your airways, look for the following signs which could indicate that you have a chest infection:⁵

1. A chesty cough with bringing out yellow/green mucus
2. Wheeze 
3. Chest tightness
4. Fever
5. Headache
6. Muscle aches
7. Tiredness

Most chest infections get better on their own within a couple of weeks. 

But you need to contact your GP or call 111 if you have:

1. Worsening cough
2. Sputum mixed with blood
3. Cough for more than 3 weeks
4. If you are pregnant or more than 65 years of age
5. If your immunity is weak due to immune-suppressing drugs or diabetes
6. If you have long-term conditions of your heart, lungs or kidneys.

 In conditions where the diagnosis is unknown or a diagnosis of infection or cancer is suspected, testing of the sputum sample is done. In cystic fibrosis, regular testing of phlegm is performed to look for infection.1² This involves collecting a sample of the sputum, preferably early in the morning before eating or drinking anything.³ After expelling the saliva, the patient is encouraged to breathe deeply and cough at 2-minute intervals until sputum is brought out. A thick sample of about 10-20 ml phlegm is most useful for the laboratory staff, whereas thin, runny samples are not accepted.

In a study by Johnson et al., a sputum sample that was white or clear was less likely due to bacterial infection, in such cases viruses or allergies are usually implicated.¹¹ A sputum stained with blood could be due to repeated coughing,however if it happens it is advisable to seek immediate medical help. Coughing out blood can be seen in chronic conditions like bronchiectasis, but we need to rule out serious conditions like pneumonia, tuberculosis and cancer. In five percent of people coughing up blood for the first time, the bleeding will be severe and life-threatening. They should call 999 in such cases.¹³

Summary

In short, this article explored what sputum is and how it can be managed. Any phlegm that is increased in quantity, thickness or of a different color than normal needs to be evaluated carefully. Chronic conditions need regular expelling of sputum with the help of a physiotherapist or medicines. Avoiding active and passive smoke, allergens, pollutants and infection sources are preventive steps toward healthier lungs. When blood is seen in the sputum, it is important to be aware and seek help at the right time.