Differing perspectives of sputum and its expectoration: A qualitative study involving patients with cystic fibrosis and physiotherapists

Abstract

Sputum specimens are frequently requested from individuals with chronic suppurative conditions such as cystic fibrosis (CF). For a proportion of people, expectorating sputum can be difficult. Our goal was to explore the potential barriers and facilitators to expectorating sputum from the perspective of those with CF and physiotherapists involved in their care. Eighteen interviews were conducted with people who have CF and three focus groups with physiotherapists. Data were recorded, transcribed verbatim, and analysed using a framework approach. Variation emerged in perceptions between physiotherapists and people with CF in terms of sputum's impact on everyday life and the importance of its role in managing the condition. These differences were reflected in the following themes: (1) seepage of bodily boundaries, (2) discrediting nature of sputum, (3) embodied representation of chronic illness, and (4) non-production as a decisional balance. Differing views between participants could have arisen from the personal nature of sputum for people with CF, whilst physiotherapists may see sputum specimens as a necessary part of holistic management of this condition. Education could assist individuals in overcoming some of the barriers associated with expectorating, but physiotherapists may have to individualise the collection of sputum, recognising not everyone will be at ease with this procedure.

‘All illness is personal to that individual’: a qualitative study of patients’ perspectives on treatment adherence in bronchiectasis

“…Embarrassment and social stigma associated with sputum and coughing due to bronchiectasis was noted. This could be due to perceptions that the expectoration of sputum was socially unacceptable, as has been reported in CF and this belief may have been reinforced by recent large‐scale public health campaigns about infection control.…”

Reliability and Minimum Important Difference of Sputum Weight in Bronchiectasis

“…[8][9][10] Qualitative studies have reported that people with bronchiectasis and cystic fibrosis use airway clearance interventions as a strategy to manage sputum symptoms and improve self-confidence in social settings. 11,12 If they completed interventions prior to engaging in social activities, the need to cough and expectoration will likely be reduced and, thus, embarrassing situations related to sputum are less likely. 11,12 Therefore, the patient's perception might be focused on the change of sputum expectoration experienced after intervention and not during the session itself.…”

“…11,12 If they completed interventions prior to engaging in social activities, the need to cough and expectoration will likely be reduced and, thus, embarrassing situations related to sputum are less likely. 11,12 Therefore, the patient's perception might be focused on the change of sputum expectoration experienced after intervention and not during the session itself.…”

The active cycle of breathing technique: A systematic review and meta-analysis

“…Clinicians have been shown to commonly use sputum production in patient assessment, and patients commonly consider sputum production in their own assessment of the efficacy of airway clearance techniques such as the ACBT. 9,10 The outcome of sputum volume has been identified as a relevant, inexpensive, minimally invasive, easily accessible and clinically useful marker to monitor response to therapy in people with cystic fibrosis 11 and bronchiectasis. 12 In people with bronchiectasis, daily sputum volume has been identified as an important prognostic indicator, with people with higher daily sputum volume having poorer quality of life.…”