Expectoration

Expectoration entails the passage of sputum out of the respiratory tract, excluding saliva. The interpretation of expectoration includes the following points:

• Onset:- 

1. Acute (Acute Bronchitis, Pneumonia, Acute Abscess & Empyema with bronchopleural fistula)
2. Gradual (TB, Chronic Bronchitis & Bronchiectasis) 

• Course:-

1. Progressive (Infection uncontrolled by antibiotics)
2. Regressive (Spontaneous improvement or good response to the antibiotics used)
3. Intermittent (Chronic Bronchitis & Bronchiectasis) 

• Duration:-

1. Long duration (Chronic Bronchitis & Chronic Lung Abscess)
2. Short duration (Acute Bronchitis, Pneumonia & Acute Lung Abscess) 

• Amount:- Big amount = >100 cc (bronchorrhea), due to Chronic Suppurative Lung Diseases which are:

1. Bronchiectasis
2. Chronic Lung Abscess 
3. Infected Cystic Lung
4. Empyema with Bronchopleural Fistula 

It also may be due to: Chronic Bronchitis, Asthma, Alveolar Cell Carcinoma & Acute Organophosphorous Poisoning 

• Colour:- It may be diagnostic:

1. Greenish (Infection with gram negative organism e.g. Pseudomonas due to formation of pyocyen pigment)
2. Rusty (Golden brown sputum due to altered haemoglobin in Stretococcal Pneumonia)
3. Red Current Jelly (Klebsiella Pneumonia & Bronchial Adenoma)
4. Haemoptysis (Bloody sputum)
5. Anchovy Sauce (Chocolate coloured sputum in Amoebic Lung Abscess)
6. Black (Melanoptysis in smokers, coal workers pneumoconiosis & Mucormycosis)
7. Reddish Tinge (Aerosolized brochodilators, Serratia Marcens Pneumonia & Secondary inhalation of iron oxide in glass sanders)
8. Blue (Copper miners)
9. Watery (Alveolar Cell Carcinoma)
10. Tricoptysis (Cough of hair due to rupture of dermoid cyst into a bronchus)
11. Chalky material/small stones (Broncholithiasis which is due to prior infections with TB, Histoplasmosis or Coccidiodomycosis)

• Aspect:-

1. Frothy sputum in Pulmonary Edema
2. Purulent sputum in Suppurative Lung Disease
3. Thick mucoid pellets in Bronchial Asthma 

• Odour (smell):-  It may be diagnostic:

1. Offensive putrid (Anaerobic organism infection in Suppurative Lung Disease)
2. Distinctive (Gram negative infection, similar to E-coli on a culture medium)

• Relation to time:-

1. Day (Morning cough of smokers or Suppurative Lung Disease)
2. Night (Bronchial Asthma, Cardiac Asthma or Acute Pulmonary Edema) 
3. Variable Morning or Nocturnal (Bronchial Asthma)
4. All over the day

• Relation to posture:- Only in Suppurative Lung Disease

1. Leaning forward or praying in Bronchiectasis
2. Lying on healthy side in Chronic Lung Abscess 

• Associated haemoptysis

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6 Cardinal Symptoms of Respiratory System:

1. Cough
2. Expectoration
3. Wheezes
4. Haemoptysis
5. Dyspnea
6. Chest pain