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Sputum is mucus and is the name used for the coughed-up material (phlegm) from the lower airways (trachea and bronchi). 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 (see below). Any hint of yellow color suggests an airway infection (but does not indicate between the types of organisms causing it). 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 (bronchitis, bronchopneumonia, or pneumonia).
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 sub group of severe asthma patients have airway inflammation that is resistant to treatment with corticosteroids.
Green or greenish colored - indicative of longstanding respiratory infection (green from degenerative changes in cell debris) 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 (mucopurulent) 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 (such as a white sink surface) 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 (this last choice tends to suggest a chronic allergic bronchitis).
A white, milky, or opaque (mucoid) appearance means that antibiotics are less likely to be effective in treatment because the likelihood is greater of a viral infection or allergy (even asthma...thick sputum) than of antibiotic-responsive micro-organisms.
^Clinical Microbiology procedures handbook, American Society for Microbiology 2nd Ed. 2007 update
^Gershman, Neil H.; Liu, Hong; Wong, Hofer H.; Liu, Jane T.; Fahy, John V. (August 1999). "Fractional analysis of sequential induced sputum samples during sputum induction: Evidence that different lung compartments are sampled at different time points". Journal of Allergy and Clinical Immunology. 104 (2): 322-328. doi:10.1016/S0091-6749(99)70374-X. PMID10452752.