Relationship of Sputum Color to Nature and Outpatient Management of Acute Exacerbations of COPD

Stockley, Robert A.; O’Brien, Claire; Pye, Anita; Hill, Susan L.

doi:10.1378/chest.117.6.1638

Cited by 463 publications

(372 citation statements)

References 23 publications

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“…However, their study included individuals with severe and very severe COPD, and these criteria have never been validated in patients with nonobstructive chronic bronchitis. More recently, STOCKLEY et al [3] observed that purulent sputum alone, compared with mucoid sputum, was significantly associated with the presence of bacteria during an exacerbation. The change to a darker colour of sputum during an exacerbation is clinically detectable and would be consistent with increased neutrophil recruitment, indicative of a new or significant bacterial stimulus.…”

mentioning

confidence: 99%

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Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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We examined the correlation between sputum colour and the presence of potentially pathogenic bacteria in acute exacerbations of chronic bronchitis (AECBs).Data were pooled from six multicentre studies comparing moxifloxacin with other antimicrobials in patients with an AECB. Sputum was collected before antimicrobial therapy, and bacteria were identified by culture and Gram staining. Association between sputum colour and bacteria was determined using logistic regression.Of 4,089 sputum samples, a colour was reported in 4,003; 1,898 (46.4%) were culture-positive. Green or yellow sputum samples were most likely to yield bacteria (58.9% and 45.5% of samples, respectively), compared with 18% of clear and 39% of rust-coloured samples positive for potentially pathogenic microorganisms. Factors predicting a positive culture were sputum colour (the strongest predictor), sputum purulence, increased dyspnoea, male sex and absence of fever. Green or yellow versus white sputum colour was associated with a sensitivity of 94.7% and a specificity of 15% for the presence of bacteria.Sputum colour, particularly green and yellow, was a stronger predictor of potentially pathogenic bacteria than sputum purulence and increased dyspnoea in AECB patients. However, it does not necessarily predict the need for antibiotic treatment in all patients with AECB.

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confidence: 99%

“…The change to a darker colour of sputum during an exacerbation is clinically detectable and would be consistent with increased neutrophil recruitment, indicative of a new or significant bacterial stimulus. This darkening of sputum colour represents the presence of myeloperoxidase, which is the green-coloured enzyme from neutrophil azurophil granules [3].…”

mentioning

confidence: 99%

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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“…With regard to antibiotic therapy exists evidence to support the antibiotic-therapy in exacerbations in which there is toning purulent sputum 35 or when mechanical ventilation is indicated. 36 As regards the choice of antibiotics, it is useful to proceed to the classification of the individual patient in one of the three risk groups for therapeutic failure, unfavorable outcome and onset of resistance, as indicated in Table 1, which defines, for each group, the characteristics of the patient, the more likely bacterial etiology and then the antibiotics of choice for empirical therapy.…”

Section: Management Of Chronic Obstructive Pulmonary Disease In Emergmentioning

confidence: 99%

Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

Ventrella¹,

Mastroianni

Errico

2014

Ital J Med

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“…When symptoms of breathlessness and cough are increased and sputum is purulent and increased in volume, provide antibiotic cover for the major bacterial pathogens involved in exacerbations -Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma catarrhalis -taking into account local patterns of antibiotic sensitivity [31,32] ** . In primary care it is usually necessary to administer antibiotics prior to the results of sputum culture, if sputum culture has been performed.…”

Section: Antibioticsmentioning

confidence: 99%

International Primary Care Respiratory Group (IPCRG) Guidelines: Management of Chronic Obstructive Pulmonary Disease (COPD)

Bellamy¹,

Bouchard

Henrichsen

et al. 2006

Primary Care Respiratory Journal

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Summary COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. This IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines. It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients.

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Relationship of Sputum Color to Nature and Outpatient Management of Acute Exacerbations of COPD

Cited by 463 publications

References 23 publications

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis

Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

International Primary Care Respiratory Group (IPCRG) Guidelines: Management of Chronic Obstructive Pulmonary Disease (COPD)

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