Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Murray, Maeve; Pentland, J L; Turnbull, Kim; MacQuarrie, S; Hill, Adam T.

doi:10.1183/09031936.00163208

Cited by 108 publications

(112 citation statements)

References 19 publications

(19 reference statements)

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“…We have extended the total number of observations by including a very large sample of patients from many centres in Europe and North America, including not only individuals with COPD but also those with nonobstructive chronic bronchitis. The results suggest that the yellow, and particularly green, sputum colour is a good marker for the presence of a PPM across the spectrum of chronic bronchial disease, including acute cough [17], stable COPD [18] and bronchiectasis [19].…”

Section: Discussionmentioning

confidence: 97%

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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Section: Discussionmentioning

confidence: 97%

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

Miravitlles

Kruesmann²,

Haverstock³

et al. 2011

Eur Respir J

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“…Severe bronchiectasis was defined as meeting all of the following clinical, microbiological and radiological criteria: expectorating purulent sputum when stable assessed using a standardised sputum colour chart [12]; chronic sputum colonisation (defined as pathogenic bacteria cultured in at least two sputum samples when clinically stable in the preceding 12 months) and at least three lobes affected on CT scan, with evidence of varicose or cystic bronchial dilatation in at least one lobe (for the purposes of this study, the lingula was considered as a separate lobe). Mild bronchiectasis was defined as meeting all of the following clinical, microbiological and radiological criteria: expectorating mucoid or no sputum when clinically stable assessed using a standardised sputum colour chart [12]; evidence of cylindrical bronchiectasis on CT scan in three or fewer lobes; and no evidence of chronic sputum colonisation. All other patients were classified as having moderate bronchiectasis.…”

Section: Validitymentioning

confidence: 99%

Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis

Murray¹,

Turnbull²,

MacQuarrie³

et al. 2009

Eur Respir J

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151

121

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Health-related quality of life is a potentially important marker for evaluating existing and new therapies in bronchiectasis. The Leicester Cough Questionnaire (LCQ) is a symptom specific questionnaire designed to assess the impact of cough severity, a major symptom of bronchiectasis. This study aimed to validate the LCQ in bronchiectasis.The validity, responsiveness and reliability of the LCQ were assessed as follows: ability to discriminate severe and mild disease; change in score following antibiotic treatment for exacerbations; repeatability over a 6-month period in stable disease; and comparison with the St George's Respiratory Questionnaire (SGRQ).In total, 120 patients (51 with severe disease, 29 with moderate disease and 40 with mild disease) completed the LCQ and SGRQ. The area under the receiver-operator curve was good for both severe and mild disease (0.84 and 0.80 respectively, p,0.0001). Following 2 weeks' antibiotic treatment, the median LCQ score (interquartile range) improved from 11.3 (9.3-13.7) to 17.8 (15-18.8) (p,0.0001). The LCQ score was repeatable over 6 months in stable disease (intraclass correlation coefficient of 0.96 (95%CI 0.93-0.97), p,0.0001). Correlation between the LCQ and SGRQ scores was -0.7 in both stable disease and exacerbations (p,0.0001).The LCQ can discriminate disease severity, is responsive to change and is reliable for use in non-cystic fibrosis bronchiectasis.

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“…This method can be easily introduced into clinical practice 25 and can help clinicians and researchers to plan appropriate therapies.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Purulence on Ciliary and Cough Transport in Bronchiectasis

et al. 2013

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BACKGROUND: Individuals with bronchiectasis exhibit colonization and infection of the respiratory system, with a consequent alteration of the macroscopic appearance of secretions, which ranges from mucoid to purulent. Purulence is related to the structural conformation, rheological profile, and transport indexes of mucus. We analyzed and compared the transport properties of respiratory secretions with mucoid appearance versus those with purulent appearance in patients with bronchiectasis and in subjects without lung disease. METHODS: In a simulated cough machine we assessed the mucociliary transport and contact angle of 32 mucoid and 19 purulent samples from subjects with bronchiectasis, and 21 samples from subjects without lung disease. RESULTS: Mucociliary transport was lower in the mucoid samples (0.78 ؎ 0.22) and in the purulent samples (0.73 ؎ 0.22) than in the samples from subjects without lung disease (1 ؎ 0.19). The purulent samples had less displacement in the simulated cough machine (7.57 ؎ 3 cm) than did the mucoid samples (23 ؎ 15 cm) or the samples from subjects without lung disease (34 ؎ 8.4 cm), as did the mucoid samples compared to the samples from subjects without lung disease. The purulent samples had a higher contact angle (25 ؎ 6.1°) than the mucoid samples (17 ؎ 7.8°) or the samples from subjects without lung disease (10 ؎ 2.5°), as did the mucoid samples compared to the samples from subjects without lung disease. CONCLUSIONS: Respiratory secretions in individuals with bronchiectasis have poor transport properties, which manifest as reduced mucociliary transport, reduced mucus transport by cough, and higher contact angle. These features were more accentuated in the purulent samples. This simple classification can be used by therapists to plan treatments, and by researchers to obtain more homogeneity between groups of subjects.

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Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasis

Cited by 108 publications

References 19 publications

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

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

Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis

The Influence of Purulence on Ciliary and Cough Transport in Bronchiectasis

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