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Why Sputum Colour?

Why is Sputum Colour Important?
Patients with COPD differ in the number and severity of their symptoms.  Breathlessness doing things is usually present, and cough and sputum (phlegm) production occur in many patients.  If you have COPD it is important that you become familiar with your usual state.  When this usual state changes, you will then be able to be clear about what has changed, as this will affect your treatment.  The BronkoTest COPD Monitoring Pack will enable you to note your usual state by providing you and your doctor/healthcare professional with the information and materials that you will require.

Once you and your doctor/healthcare professional are used to your normal state, you will be able to use the Bronkotest Action Plan to help you recognise changes in your symptoms and sputum and to determine what treatment is appropriate.

Exacerbations of COPD are a major cause of poor health, and require an increase in usual treatment and/or the introduction of new treatments such as a course of steroids or antibiotics (refs. 1 & 17).

Antibiotic treatment is widely useful but often not needed because it is difficult to be sure when there is an infection with bacteria.  Because doctors are cautious and do not want to miss an opportunity to help patients by treating a bacterial infection, antibiotics are often given when they are neither needed nor helpful.  When antibiotics are prescribed needlessly, it is becoming more and more common for them to be ineffective when they are needed for later infections.  For this reason, a means of determining when a chest infection is caused by bacteria is very valuable.

When faced with an infection caused by bacteria, the body normally responds by using its own natural defences.  Antibiotics are needed when these defences fail, and antibiotics can also add to the body’s defences to speed recovery from bacterial infections.  In the lung it is relatively easy to detect when the natural defence response to bacteria is overrun by assessing the colour of the sputum (phlegm).  The last line of defence when all else fails involves the blood neutrophils (usually known as white blood cells) which get called into the lung to fight the infection.  If you cough up sputum, these cells and the bacteria can be seen under the microscope.  However, that often doesn’t help the doctor/healthcare professional decide whether an infection is present because it is difficult to carry this out in the clinic and some cells and bacteria can be present even when there is no infection that needs treating.

A simpler way is to look at the colour of the sputum.  This is because the white blood cells are in fact a very pale green colour.  They contain a protein called myeloperoxidase which is only present in white blood cells and is green in colour.  Thus the more white blood cells present in the sputum in response to bacteria, the more obvious the green colour becomes.  The colour change also indicates how likely it is that bacteria are present as well as how many bacteria are present.  Therefore colour can be used to identify who requires antibiotics for treatment of exacerbations.  If the antibiotic treatment is right the bacteria are killed and the need for white blood cells decreases so they no longer move to the lungs and the colour of the sputum clears.  This can be easily detected and monitored by patients. 







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