Sputum characteristics and airway clearance methods in patients with severe COVID-19

Abstract

Critically ill patients with coronavirus disease 2019 (COVID-19) have a high case fatality rate. Hence, controlling the disease progression of severely ill COVID-19 patients to avoid the development of severe-to-critical COVID-19 is the most important target of COVID-19 treatment. The latest autopsy results of COVID-19 patients have shown the presence of viscous secretions in the airways. However, no studies are available that specifically describe and analyze the sputum characteristics and the effects of various sputum drainage methods on the prognosis of COVID-19 patients. In our study, we found that elderly COVID-19 patients were more susceptible to progression to critical illness ( P = .024) and were likely to have accompanying lymphopenia ( P = .035) or increased neutrophil counts ( P = .019). We observed that there was a higher proportion of patients with Grade 3 sticky sputum in the critically ill group than in the noncritically ill group ( P = .026), suggesting that changes in sputum characteristics may be one of the early warning signs of critical COVID-19. In addition, we found that the application rates of large doses of ambroxol ( P = .043) and prone-position drainage ( P = .037) were relatively high in COVID-19 patients with good prognoses, suggesting that the early application of large doses of expectorant drugs and prone-position drainage in COVID-19 patients may avoid progression to critical illness and improve the prognosis.

COVID‐19 end‐of‐life care: symptoms and supportive therapy use in an Australian hospital

“…The incidence of excess respiratory secretions in our cohort was lower than the 35% prevalence reported in a systematic review of the general population dying from all causes, despite COVID‐19 being largely a respiratory illness (and respiratory illnesses being a common cause of death in the population) 15 . This suggests that the degree of respiratory secretions, though noted to be thick and of large quantity in the lower airways, still does not affect patients as much as within the general population 16 …”

“…Anticholinergic anti‐secretory agents work by reducing the production and accumulation of respiratory secretions, and are deemed to be more effective in patients with low amounts of secretions 23 . Critically ill COVID‐19 patients are known to have large amounts of thick sputum in the lower airways 16 ; as such, the use of anti‐secretory agents in this group of patients may not be as helpful.…”

“…15 This suggests that the degree of respiratory secretions, though noted to be thick and of large quantity in the lower airways, still does not affect patients as much as within the general population. 16 Agitation was the second most common symptom, 2,4,8 the degree peaking between the final 48-72 h period of life before plateauing or improving on the day of death. This may reflect the comparatively higher doses of opioids and midazolam administered on the day of death, along with a reduced conscious state closer to death.…”

Yield of Severe Acute Respiratory Syndrome Coronavirus 2 Lower Respiratory Tract Testing After a Negative Nasopharyngeal Test Among Hospitalized Persons Under Investigation for Coronavirus Disease 2019

“…First, it is a single-site study and may not reflect URT and LRT testing practices in other populations. Second, our study was nonrandomized; patients with COVID-19 may be more likely to have lower respiratory symptoms and produce sputum than PUI without COVID-19 infection [ 20 ], so LRT NAAT may have been more likely to be performed on PUI with COVID-19. Last, we were unable assess the relative value of expectorated sputum and tracheal aspirate specimens in our full study population; however, all but 1 subject diagnosed on LRT NAAT had testing performed on expectorated sputum.…”

COVID-19: A New Challenge for Pulmonary Rehabilitation?

“…COVID-19 survivors often report post-covid complications such as shortness of breath, fatigue, muscle pain, and weakness. Moreover, it was discovered that severe coronavirus pneumonia is associated with abnormal mucus production in the form of viscous and bloody secretions in airways caused by systematic inflammatory cytokine storm [ 3 , 4 ]. Consequently, respiratory functions are disturbed by lung fibrosis, airflow reduction, and respiratory muscle fatigue; therefore, the necessity of comprehensive pulmonary rehabilitation applied together with pharmacotherapy is indisputable.…”