Sputum analysis (What is it for and what does it show). Sputum analysis Sputum bacterial analysis

Algorithm for collecting sputum for bacteriological examination

Preparation for the procedure:

Introduce yourself to the patient, explain the process and purpose of the procedure

2.. Collect sputum only when coughing, not expectorating.

Personal hygiene must be observed before and after sputum collection
Make sure that the patient brushes his teeth in the evening and rinses his mouth and throat in the morning boiled water immediately before collection. (if necessary, this procedure is monitored by junior medical personnel)
Treat hands hygienically and dry.
Wear gloves and mask

Executing the procedure

Open the lid of the jar
Ask the patient to cough and collect sputum in a sterile jar in an amount of at least 5 ml. During the collection, the m/s hands the jar from behind the patient’s back.
Close the lid

End of the procedure

Remove the mask, gloves, place in a container for disinfection
Treat hands hygienically and dry
Make a referral
Make an appropriate entry about the results of the implementation in the medical documentation

Arrange delivery of the analysis to the laboratory

Additional information about the features of the technique

Make sure that the sputum does not get on the edge of the jar and do not touch inner surface lids and jars

Freshly isolated sputum is examined no later than 1-1.5 hours

IN bacteriological laboratory sputum is delivered in a sealed container.

Patient informed consent form when performing the technique and additional information for the patient and his family members

Upon admission to the hospital, the patient signs a voluntary informed consent on medical intervention(based on Articles 32, 33 “Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens” order No. 101 dated March 29, 2011);
Treatment in a hospital can be carried out for the patient by court decision.

3. The patient must be informed about the upcoming study. Information about taking sputum for bacteriological examination, communicated to him medical worker, includes information about the target this study. Written confirmation of the consent of the patient or his relatives to take sputum for bacteriological examination is not required, since this diagnostic method is not potentially dangerous to the life and health of the patient

Parameters for assessing and quality control of the method implementation

— Availability of a record of the results of the prescription in the medical documentation.

— Timely execution of the procedure (in accordance with the appointment time).

- No complications.

— There are no deviations from the execution algorithm

— Patient satisfaction with the quality of medical services provided

Phlegm is the mucous contents in the airways and lungs that are expelled when you cough. With the development of the pathological process, the nature and amount of secretion changes. To establish the disease, it is prescribed general analysis sputum.

Bronchitis is inflammatory disease, in which the airways in the bronchi area are affected. Normally, there is a minimal amount of mucus on the inner surface of the bronchi. When an inflammatory process develops in the bronchi, tissue swelling and the production of large amounts of mucus are observed. Against this background, breathing becomes difficult and a cough develops.

The development of bronchitis occurs when it enters the body viral infection. The causative agents of the disease can be influenza viruses and adenoviruses. Activates the inflammatory process and reduces protective functions body. Immune system cannot fully fight pathogenic microorganisms.

Other causes of bronchitis:

Allergic reaction
Hereditary predisposition
Ecological situation
Bad habits

Bronchitis can occur in two forms: acute and chronic. During the acute form, the inflammatory process lasts about 2 weeks. The cough is dry at first, and after a while becomes wet with sputum discharge. Long lasting acute form bronchitis leads to a chronic course.

Symptoms of chronic bronchitis can last for about 3 months.

The following symptoms are characteristic of bronchitis:

Pain and tightness in the chest.
Hesitant breathing.
Sore throat.
Prolonged cough with sputum.
Wheezing.
Low-grade body temperature.

The main symptom of bronchitis is severe cough, which intensifies in the evening. The sputum produced when coughing may be yellow or white. Sputum of this color indicates the bacterial nature of the inflammation. In addition, the sputum may turn brown or pink. These are breakdown products and this state requires immediate medical attention. The color of the mucus characterizes the severity of the disease.

If bronchitis with sputum is detected, the doctor will prescribe a bronchial mucus analysis. Further treatment will depend on the results obtained.

Preparation for analysis and execution procedure

To obtain reliable results, before the procedure it is necessary to rinse your mouth with boiled water and soda. For better sputum removal on the eve of the test, it is recommended to drink more fluid.

Sputum collection is performed in the morning before meals. The patient takes three deep breaths and clears his throat. The mucus is collected in a sterile container with a capacity of 25-50 ml. At the same time, it should be wide so that the patient can spit the sputum inside.If sputum collection is carried out in outpatient setting, the nurse will inform you about the progress of the procedure.

If sputum is difficult to separate, the patient is given inhalations using sodium chloride and sodium bicarbonate, diluted in distilled water.

This solution enhances the formation of saliva, and then provokes coughing and mucus discharge. First, saliva is spit into a special container, and only then proceed to collecting sputum.After inhalation, the patient may experience residual mucus secretion for some time.

The study is carried out no later than 2 hours after sputum collection. If sputum must be transported to another medical institution, then you need to store the container with the contents with a tightly closed lid in the refrigerator for no more than 2-3 days. During transportation, the container with sputum must be protected from exposure to sunlight.

The results of the study may be affected by improper collection of mucus and untimely delivery to the laboratory.Sputum analysis involves macroscopic, microscopic and microbiological examination.

Normally, the volume of secreted secretion should be 10-100 ml per day. Every healthy person swallows this amount and does not notice it.

Mucous sputum is characteristic of bronchitis and tracheitis. When mucous sputum with purulent contents appears, bronchopneumonia is diagnosed. Serous contents indicate pulmonary edema, and purulent sputum indicates bronchiectasis, staphylococcal pneumonia, abscess, pulmonary actinomycosis.

If red spots are observed in the sputum, this may indicate tuberculosis, abscess or lung cancer, pulmonary edema.

If sputum has a rusty tint, pneumonia, pulmonary congestion, or edema are diagnosed.

Sputum should normally be odorless. An unpleasant odor appears when the outflow of mucus is disrupted.Not large number secreted mucus is observed during bronchitis and pneumonia, as well as during an attack of bronchial asthma. A large amount of mucus discharge is associated with pulmonary edema.

At chemical research Bile pigments may be present in the sputum. This may indicate pneumonia and other diseases respiratory tract having communications between the lungs and the liver.

More information about bronchitis can be found in the video:

When examined, sputum with purulent contents is divided into 2 layers, and putrefactive sputum into 3 layers, which is typical for gangrene of the lung.

Fresh and decomposed sputum differ in the degree of reaction. In the first case it is alkaline or neutral, and in the second it is acidic. For the diagnosis of chronic bronchitis and tuberculosis, the determining factor is the presence of protein. If chronic bronchitis is characterized by a low protein content, then with tuberculosis the protein concentration will be increased and it can be quantified.

Possible pathologies

The results of microscopic examination of sputum can reveal:

Cells of flat and columnar epithelium. The first type of cells is of no diagnostic value, and the second type in single or multiple quantities may indicate bronchial asthma, bronchitis or. The presence of columnar epithelial cells may be due to improper collection, during which mucus from the nasopharynx was added to the sputum.
Alveolar macrophages. These particles are often found in people who long time were in a dusty room. The presence of hemosiderin, a breakdown product, indicates pulmonary congestion, mitral stenosis or pulmonary infarction.
. These blood cells are present in any sputum. The presence in large quantities indicates bronchial asthma, pneumonia, tuberculosis. The presence indicates the development of whooping cough or tuberculosis.
. A high concentration of red blood cells is observed with hemoptysis and pulmonary hemorrhage.
Tumor cells. Pathological cells in sputum are detected in the form of numerous groups. In the presence of single tumor cells, reanalysis.
Elastic fibers. The appearance of elastic fibers is associated with the breakdown of lung tissue, which forms during gangrene, tuberculosis, and lung abscess.

Using sputum, you can determine the type of pathogen. If during the study the bacteria are stained blue, then are considered gram-positive, and those colored pink– gram-negative. Normally, a stained smear gives a negative result during bacterioscopic examination.

Based on the results of sputum analysis, identification of the pathogen, and the nature of the contents, a diagnosis is made and appropriate treatment is prescribed. It can be difficult to determine the type of pathology only by sputum analysis, so comprehensive examination sick.

Treatment of bronchitis

At wet cough with sputum production, the patient should drink as much fluid as possible. For this purpose, you can use herbal medicines that have anti-inflammatory, expectorant and bronchodilator effects.

Treatment of bronchitis is aimed at eliminating the infection and restoring bronchial patency. To suppress pathogens, antibiotics are prescribed (penicillins, macrolides, cephalosporins, fluoroquinolones). The doctor, taking into account the severity of the disease and the patient’s condition, prescribes certain type antibiotic and duration of treatment.

At long-term use antibacterial drugs for recovery intestinal microflora use probiotics.

To eliminate cough, expectorants (ammonium chloride, sodium bicarbonate, etc.), mucoregulating (Bromhexine, Ambroxol, Carbocisteine, Acetylcysteine, etc.) mucolytic drugs (ACC, Lazolvan, etc.) are used.

Herbs that have an expectorant effect include licorice, sage, mullein, elecampane, plantain, etc.

In the absence of contraindications, it is useful to perform inhalations. Such procedures help moisturize the mucous membrane, reduce the excitability of the cough reflex, and thin the sputum.

Treatment should only be prescribed by a doctor. Self-administration of medications is strictly prohibited.

Sputum is a secretion released during inflammation of the trachea, bronchi and lungs. Its appearance is noted not only with damage to the respiratory organs, but also with disorders of the heart and blood vessels. Methods for examining sputum involve macroscopic, chemical and microscopic determination of its characteristics.

What does the analysis reveal?

Sputum examination makes it possible to detect microorganisms that cause pathological process, indicate the presence of mycobacteria in tuberculosis, identify cancer cells, blood and purulent impurities, as well as determine the resistance of bacteria to antibiotics.

For what conditions is analysis indicated?

General analysis is carried out in the following conditions:

cough;
pneumonia;
inflammation of the bronchi;
suppuration of the lung;
tuberculosis;
bronchiectasis;
pulmonary gangrene;
tumor in the lungs;
acute bronchitis;
chronic bronchitis;
chronic tonsillitis;
tuberculosis;
whooping cough;
silicosis;
acute form of obstructive bronchitis;
pneumonia;
anthrax.

Preparing for the study

Mucus will be better released if you take an expectorant the day before the test or drink a large amount of warm drink. Before collection, it is recommended to brush your teeth and oral cavity, rinsing it with warm boiled water.

Basic collection rules

It is advisable to collect sputum in the morning (it accumulates the night before meals) into a sterile container provided by the laboratory. An amount of 5 ml is sufficient for analysis. The secretion is analyzed no later than 2 hours after its collection. Until sent for testing, the container with the contents should be stored closed in the refrigerator.

The amount of sputum in various diseases

The amount of secretion released varies depending on the nature of the pathological process. Usually it varies from several spits to 1 liter per day. A small amount is released during congestion of the lungs and at the onset of an attack of bronchial asthma. At the end of the attack the volume increases. It can be up to 0.5 l, and can also be released in large quantities if there is pulmonary edema.

A lot of mucus is released when purulent process in the lungs when communicating with the bronchi, during suppuration, bronchiectasis and gangrene.

Examination of sputum for tuberculosis shows the breakdown of lung tissue. In particular, this process is provoked by the cavity, which communicates with the bronchi.

What is the reason for the decrease or increase in secretion secretion?

An increase in the amount of secretion secreted may be associated with a deterioration in the patient’s condition and may be observed during an exacerbation. An increase may also refer to positive dynamics in the development of the disease.

A decrease in the amount of mucus secreted may indicate regression of inflammation or a violation in the area of drainage of a cavity filled with pus. At the same time, there is a deterioration in the patient’s well-being.

Nature of the discharge

Mucous secretion is released during acute or chronic bronchitis, bronchial asthma, pneumonia, cancer lung tumors, bronchiectasis, pulmonary echinococcosis, accompanied by suppuration, actinomycosis.

Sputum mixed with pus is observed with lung abscess, echinococcosis and bronchiectasis.

Mucus mixed with blood or consisting entirely of blood is characteristic of tuberculosis. The appearance of blood may indicate the presence of oncology, bronchiectasis, or suppuration of the lung. This phenomenon is also observed in the syndrome middle beat, infarction in the lung, trauma, actinomycosis and syphilitic lesions. Blood can also be released during lobar and focal inflammation of the lungs, congestive processes, cardiac asthma and pulmonary edema.

Serous sputum is observed with pulmonary edema.

Sputum color

Examination of sputum reveals its different colors. Mucous and have no color or have a whitish tint.

The addition of pus gives the secretion a greenish tint, which characterizes such pathological processes as lung abscess, gangrene, bronchiectasis, and actinomycosis of the lung.

Discharge tinged with rust or brown indicate that they do not contain fresh blood, but a product of its breakdown - hematin. Such a secret can be released in the lungs, anthrax, pulmonary infarction.

A greenish color mixed with dirt or a yellow secretion indicates a pathology of the respiratory system in combination with jaundice.

Sputum turns bright yellow in eosinophilic pneumonia.

Mucus occurs in siderosis of the lung.

A blackish or grayish secretion is noted when there is an admixture of coal dust. With pulmonary edema, serous sputum is observed in large quantities. As a rule, it is colored evenly in pinkish color, which is explained by the presence of red blood cells. Such discharge is similar to liquid cranberry juice.

The secret may also be colored from some medicines. For example, the antibiotic Rifampicin can give it a red color.

Smell

The nature of the pathological process in the respiratory organs may also be indicated by the smell of the secretion. The sputum smells rotten when lung gangrene or putrefactive lesions of the bronchi, oncological tumors, complicated by necrosis of bronchiectasis.

Availability of layers

Often, examination of secretions reveals the presence of layers. With a stagnant nature, sputum mixed with pus is observed with suppuration of the lung and bronchiectasis.

The secretion, mixed with rot, contains three layers. The top layer is foam-like, the middle layer is serous, and the bottom layer is mixed with pus. This composition characterizes lung gangrene.

Impurities

Gangrene and suppuration of the lungs cause the appearance of pieces of pulmonary necrosis. If there is a tumor, fragments may be present in the discharge.

Rice bodies, or Koch lenses, are characteristic of tuberculosis.

Dietrich's plugs, including bacterial breakdown products and lung cell tissue fatty acids, occur with putrefactive bronchitis or gangrene of the lung.

The chronic form of tonsillitis involves the release of plugs from the tonsils, similar to Dietrich's plugs.

Chemical method

Sputum examination chemically involves the definition:

Protein indicator that can help in differential diagnosis chronic form bronchitis and tuberculosis. With chronic bronchitis, traces of protein are noted in the secretion, and with tuberculosis, the amount of protein in the sputum will be much higher, and it can be indicated by numbers (up to 100-120 g/l).
Bile pigments. They are found in sputum when the respiratory system is affected in combination with hepatitis. In this case, the liver communicates with the lungs. Bile pigments are inherent in pneumonia, which is caused by the breakdown of red blood cells inside the lungs and the subsequent change in hemoglobin.

secret research

For the differential diagnosis of tuberculosis and many other lung lesions, the cytological method is widely used, which includes two stages: clinical and microscopic examination of sputum.

A clinical trial helps determine which method should be used to collect material to obtain correct result analysis.

There are two main types of material required for microscopic examination of sputum: spontaneous and reduced. The second type of secretion is obtained by exposure to various irritants (expectorants, inhalations, etc.).

Material obtained from needle biopsy

Cytological examination of sputum involves the study of macroscopic and microscopic analysis of its cells.

The most information for cytological analysis is provided by sputum taken in the morning on an empty stomach. Before testing, it should be stored for no more than 4 hours.

Cells are found in sputum squamous epithelium which are examined microscopically. But they have no significance for making a diagnosis. Columnar epithelial cells - both single and in groups - can be observed in diseases such as bronchial asthma, bronchitis and lung cancer. It should be noted that columnar epithelium can also appear due to the penetration of mucus from the nasopharynx.
Alveolar macrophages are reticuloendothelial cells. Macrophages, which are contained in the protoplasm (phagocytic particles or dust cells), can be found in patients who have inhaled dust for a long time.
Protoplasmic macrophages (formed during the breakdown of hemoglobin) are called cardiac defect cells. They can occur during congestive processes in the lungs, stenosis mitral valve, pulmonary infarction.

A small number of leukocytes are found in any sputum. Their increased content is observed in secretions mixed with pus.
Eosinophils. The sputum of asthmatics is rich in such cells. Cells can be observed in the eosinophilic form of pneumonia, helminth damage to the body, tuberculosis and pulmonary infarction.
Red blood cells. Single red blood cells do not reflect the picture of the disease. Appearance increased amount indicates the presence of bleeding in the lungs. Unchanged red blood cells are detected in fresh blood. If there is an admixture of blood that has stagnated in the lungs for a long time, then leached red blood cells are detected.
Cancer cells. They can be found in secret groups. They indicate the presence of a tumor. When single cells are found, diagnostic difficulties often arise. In such cases, a repeat sputum analysis is performed.
Elastic fibers, the appearance of which is caused by the breakdown of lung tissue, provoked by tuberculosis, abscess, gangrene, tumor. Such cells are not always characterized by gangrene, since due to the action of secreted enzymes, they can be dissolved.
Kurshman spirals. These are special bodies that look like tubes. They are detected when examined under a microscope. Sometimes visible to the eye. Typically, spirals are associated with diseases such as bronchial asthma, pulmonary tuberculosis and pneumonia.
Charcot-Leyden crystals are found in sputum with an increased content of eosinophils in diseases such as bronchial asthma and eosinophilic pneumonia. Opening a focus of tuberculosis in the lumen of the bronchi can be characterized by the presence in the secretion of elastic fiber-crystals of cholesterol, MBT and amorphous lime (the so-called Ehrlich tetrad) - 100%.

Application of bacterioscopy

Collecting sputum for examination by the bacterioscopic method involves analyzing the secretion to detect mycobacteria characteristic of tuberculosis. They look like thin sticks thickened on the sides or in the middle different lengths, which are located both individually and in groups.

The detection of Mycobacterium tuberculosis is not a dominant sign for diagnosis and requires confirmation by bacteriological methods. Tuberculous mycobacteria are not detected in secretions under normal conditions.

The basis for the analysis are purulent particles, which are taken from forty-six various areas and thoroughly rub until smooth with two glasses. Next, they are dried in air and fixed with a burner flame.

Bacteriological research The Ziehl-Neelsen method assumes that sputum is stained red. In this case, all secretion particles, with the exception of mycobacteria, acquire a blue tint, and mycobacteria acquire a red color.

If the body is suspected of being affected by tuberculosis, after testing three times for the presence of mycobacteria with a negative response, the flotation method (Pottenger analysis) is used.

The usual method for examining a stained smear for MTB gives positive result only when the amount of MTB is at least 50,000 units in 1 ml of sputum. The presence of tuberculosis cannot be judged by the number of mycobacteria.

Bacterioscopy of patients with nonspecific lung diseases

Laboratory tests of sputum in the presence of nonspecific lung diseases during bacterioscopy can reveal the following bacteria:

For pneumonia - pneumococci, Frenkel diplococci, Friedlander bacteria, streptococci, staphylococci (100%).
With gangrene of the lungs, a spindle-shaped rod can be found in combination with Vincent's spirochete (80%).
Yeast-like fungi (70%), to determine the type of which requires culture of the secretion.
Actinomycete drusen (100%) in actinomycosis.

Secretion volume in a healthy person

The volume of mucus secreted by the trachea and bronchi in a person who does not suffer from any pathologies ranges from 10 to 100 ml/day.

Normally, the level of leukocytes is low, and examination of the stained smear for mycobacteria gives a negative result.

The mucus secreted during diseases of the respiratory organs is called. In the absence of an inflammatory process, excessive production and discharge of this secretion is not observed. Normally, there is little production of sputum, which is usually swallowed unnoticed by the person. The main function of tracheobronchial mucus is to cleanse the respiratory tract of inhaled dust and other particles. Sputum consists of immunoglobulins, proteins, macrophages, glycoproteins, and lymphocytes.

Sputum examination in a laboratory is carried out to clarify the diagnosis for pathologies of the respiratory organs, lungs or bronchi. Excessive mucus secretion and the presence of foreign impurities in it may indicate serious illnesses. Sputum analysis is carried out for the following purposes:

Diagnosis of lung pathologies.
Determination of the characteristics of the disease.
Evaluation of the effectiveness of the therapy.
Tracking dynamics during chronic pathologies lungs.

If the patient has prolonged cough With copious discharge secret, then there is a need to carry out clinical analysis sputum, especially if fluoroscopy revealed dark spots on chest. Before implementation laboratory research tracheobronchial mucus, diseases can be judged by its appearance, consistency, smell and other indicators. It's about about the following types:

Green sputum indicates congestion and sinusitis.
The pearly white color of the mucus indicates a malignant process in the bronchi.
A large amount of blood along with sputum is an extreme degree of tuberculosis or lung cancer.
Clear fluid may be released during bronchitis.
Purulent sputum with sharp unpleasant smell, released after strong painful sensations in the chest, often indicates a ruptured abscess, gangrene of the lungs, etc.
Amber-colored mucus is secreted during allergies.
Streaks of blood in the mucus are found during bleeding in the lungs or with.
Liquid and transparent sputum with a foamy consistency, which contains purulent inclusions, indicates chronic bronchitis or for pulmonary tuberculosis.
Mucous discharge of a rusty color can be due to pneumonia.

Laboratory bacteriological examination of sputum is prescribed if severe pathologies of the lungs and bronchi are suspected, for example, tuberculosis, infectious lesions, cancer, etc. In the absence of suspicious inclusions, normal color and consistency, a general analysis of sputum is performed to assess the condition of the bronchi and lungs.

Main types of research:

Detection of Mycobacterium tuberculosis.
Microscopic or general analysis.
Examination of secretions for atypical cells during high probability malignant process in the lungs.
Bacteriological examination at infectious diseases lungs.

Features of the sputum collection process may vary depending on what type of research is being carried out. Most often, biomaterial collection occurs in morning time, but if necessary at other times of the day. Before coughing, you should thoroughly brush your teeth and rinse your mouth. antiseptic solution, for example, furatsilin or a weak solution of potassium permanganate. You need to spit the secretions into a special sterile container.

Before collecting sputum for laboratory testing to identify diseases of the lungs or bronchi, you should properly prepare your body. Following these recommendations will make this process easier:

The day before the expected procedure, take expectorants and drink more warm water.
Carry out the procedure in the morning, since mucus accumulates in the the right quantity and comes off easily.
If you cannot cough up the mucus, you need to inhale or take deep breaths and exhale several times in a row.
It is advisable to spit the material only into a special container sold in pharmacies.
During the procedure, make sure that only sputum, but not saliva, gets into the sterile container.

The sputum collection process itself looks like as follows: The patient should take a deep breath and exhale slowly, repeat several times. Then start coughing vigorously to release a sufficient amount of mucus, and spit it into the container. The container must be tightly closed with a lid and placed in the refrigerator. The study of this biological material must be carried out within two hours after collection, otherwise it may begin to reproduce. pathogenic microorganisms, the presence of which distorts the research results.

Collection of material during bronchoscopy

- This diagnostic procedure, intended for the study of the respiratory tract. It is performed for abscesses in the lungs, pneumonia, tuberculosis. Bronchoscopy is also prescribed if it is impossible to obtain sputum naturally, and, if necessary, examination of tracheobronchial mucus without admixtures of saliva and nasopharyngeal contents.

The procedure is contraindicated after suffered a heart attack, with pulmonary and heart failure, with exacerbation of bronchial asthma, neuropsychic disorders, etc. Before diagnosis, the patient must take blood tests, have an electrocardiogram, and an X-ray examination of the lungs. Description of bronchoscopy:

Local or general anesthesia is used.
A bronchoscope is inserted into the trachea and lungs through the nasal or oral cavity, and a sample of mucus is taken.
After the procedure, the patient is prohibited from taking blood thinning medications such as aspirin.

Laboratory tests

After collecting sputum and submitting it to the laboratory, comprehensive study biomaterial necessary to clarify the diagnosis. In this way it becomes possible to identify the most various pathologies. Main stages of sputum examination:

Microscopic.
Bacteriological.

Clinical analysis involves the study of color and smell biological fluid, its quantity, the presence or absence of foreign impurities. In the process of executing this laboratory analysis the peculiarities of the course of the disease in the lungs and other respiratory organs. Microscopic examination is the examination of a sample of tracheobronchial mucus under a microscope. Used to detect eosinophils, Kurshman spirals, leukocytes, etc.

Bacterial culture for microflora is necessary to determine the specific causative agent of the disease. This type research is prescribed when identifying high content leukocytes in sputum. This analysis also allows us to find out which antibacterial drug There is sensitivity in microorganisms that cause pathology. Bacteriological examination of sputum is often performed when pulmonary tuberculosis is suspected.

Evaluation of analysis results

Often the results of sputum analysis are incorrect. This is due to improper collection or storage of biological material, penetration of other substances or liquids into it, and untimely examination of mucus.

The attending doctor interprets the results obtained, and treatment course prescribed taking into account other laboratory and instrumental studies. Normally, the liquid in question has a mucous structure, transparency, it should not contain purulent inclusions, streaks of blood, foreign odor etc.

An excess of eosinophils indicates bronchial asthma or lung helminthiasis.
The detection of a large number of neutrophils indicates infectious lesions of the lungs (tuberculosis, acute, etc.).
In bronchial asthma, the presence of Kurshman spirals in the mucus is noted.
The detection of Charcot-Leyden crystals confirms the diagnosis of bronchial asthma.

If tracheobronchial mucus is collected incorrectly during the examination, increased concentration squamous epithelial cells (more than 25). This is often observed when there is a large amount of saliva in the biomaterial. It may also be associated with the breakdown of lung tissue due to widespread tuberculosis or inflammation of the lungs with an abscess. Referrals for sputum examination are issued by the following specialists:

Therapist.

Compliance with medical recommendations regarding correct collection biomaterial, will help to obtain the most reliable results studies on the basis of which it is prescribed correct treatment identified pathologies of the lungs and other respiratory organs.

Sputum is a viscous secretion of the mucous membrane of the respiratory tract. IN healthy body its quantity is minimal. During inflammatory processes, sputum production increases significantly.

This is a kind of protective mechanism that removes infectious pathogens and their waste products from the bronchi and lungs. Sputum examination allows you to determine the nature of inflammation of the respiratory system and carry out differential diagnosis diseases.

General characteristics of sputum analysis

The study of discharge obtained from the bronchi is carried out in several stages.

Clinical analysis

This visual examination sputum. The laboratory technician describes the following characteristics:

The total amount - in the pathological process increases in proportion to the severity.
Color.
Smell.
Presence of impurity. With the naked eye you can see streaks of blood and pus.

Using clinical analysis, it is quickly determined how serious the pathological process is developing in the respiratory tract.

Microscopic analysis

Reveals various cells: , red blood cells, eosinophils and other elements.

Bacteriological analysis

A special study to differentiate various types infectious agents. It is prescribed for indirect signs bacterial inflammation - the presence of pus upon visual examination, which is confirmed a large number leukocytes under microscopy.

Additionally, the sensitivity of microorganisms to antibiotics is determined, which greatly facilitates the treatment of the disease.

Indications

The list of diseases for which sputum examination can help in treating a patient is quite extensive. Let's list some of them:

Acute inflammatory processes: bronchitis, pneumonia.
Specific infections - whooping cough.
Chronic diseases of an infectious nature: tuberculosis, lung abscess.
Non-infectious processes: bronchiectasis, chronic bronchial obstruction, bronchial asthma, emphysema and others.
Oncology.

In most cases, sputum analysis is ordered as a additional method research to clarify the diagnosis. it is fundamental in diagnosis.

Material collection rules

Patients often have difficulty collecting sputum. To facilitate this process and ensure the reliability of the results, several rules should be followed:

Sputum is always collected in the morning, since it accumulates in sufficient quantities at night.
The minimum amount to be obtained is 1 ml. Ideally - 3 ml.
Before collection, the patient sits in front of an open window.
First, it is recommended to take two slow deep breaths with a slight breath hold.
On the third inhalation, the patient stands up to maximize the expansion of the lungs and exhales sharply. If the diaphragm connects to the lungs as a result of these movements, it will provoke a cough impulse, and phlegm will come out. It is immediately spat out into the prepared container.
Dishes for collecting material must be sterilized (usually by boiling, but there are also ready-made vessels).
No saliva allowed. If there is not enough material, you can make several cough pushes. The lid of the container is opened only at the moment of spitting; the rest of the time it should be closed.
The following methods stimulate sputum production: taking expectorants, irritating inhalations, drinking plenty of warm water, and physical exercise.
If the patient is severely weakened or sputum must be collected from small child, need to sterile wipe touch the root of the tongue, thereby causing a cough. In this case, part of the secretion from the bronchi gets onto the napkin. It is quickly transferred from a napkin to a glass slide and immediately sent to the laboratory.

To collect the material, choose a transparent container with a wide neck (for ease of spitting) and an airtight lid. The material should be delivered for examination no later than 2 hours.

Only then will the results not be distorted (extra microorganisms may have time to multiply in the sputum, and the result will become false positive). The collected material should only be stored in the refrigerator.

Interpretation of results

U healthy person bronchial secretion swallowed as its value is negligible. If the patient can spit out sputum, then its amount has increased. This indicates a disease of the respiratory system.

Let's look at what results a sputum test can show:

A viral disease is a transparent, viscous secretion. This discharge is characteristic of an acute inflammatory process.
The admixture of blood is the most dangerous symptom characterizing a serious pathology: tuberculosis, cancer, systemic damage connective tissue. Sometimes small streaks of blood occur with a very strong, dry cough (whooping cough, tracheitis with the flu).
Allergic sputum has a viscous consistency and an amber tint.
Purulent sputum usually characterizes bacterial infection. The discharge is cloudy, yellow-green, sometimes whitish. This symptom occurs in many diseases - bronchitis, pneumonia, sinusitis, lung abscess and others.
Serous sputum is characteristic of pulmonary edema. It contains an increased amount of liquid component.
If leukocytes are found in the secretion in numbers exceeding 25 thousand in the field of view, this indicates inflammation, most often of a bacterial nature.
At microscopic examination a large number of eosinophils can be detected. Then they immediately assume helminthic infestation, in which coughing or an allergic reaction is also common.
Specific signs of bronchial asthma are Kurshman spirals and Charcot-Leiden crystals. The first are “casts” of small bronchi, consisting of viscous secretion. Crystals are formed from the secretion of eosinophils and are excreted in the sputum in the form of oblong pyramids.
Elastic fibers. Their detection is always alarming, as it happens when lung tissue is destroyed (tuberculosis, tumor, abscess pneumonia).

Table for interpretation of the results of microscopic examination of sputum

Cells	Result
	Flat - usually indicates improperly collected material when saliva gets into the sputum. The detection of columnar epithelium indicates bronchitis, bronchial asthma or lung cancer.
Alveolar macrophages	The result of a long stay in a dusty room. Sometimes hemosiderin, a breakdown product of hemoglobin, is detected along with them (this is a sign of mitral stenosis, pulmonary infarction, stagnation)
Leukocytes	If eosinophils predominate - bronchial asthma, pneumonia, tuberculosis If lymphocytes - tuberculosis, whooping cough
Red blood cells	A sign of a violation of the integrity of the lung tissue - destructive forms tuberculosis. tumor
Tumor cells	Detection of atypical cells is significant only when there is a large accumulation of them. If single ones are present, the study is repeated.
Elastic fibers	Decay of lung tissue due to tuberculosis, tumor, abscess

Features of sputum analysis for bronchitis

Bronchitis is a disease of the respiratory tract that usually complicates the course of a viral infection.

Inflammation of the bronchial mucosa is caused by bacteria, viruses or allergic reaction. Treatment for bronchitis varies greatly depending on the cause, so sputum examination is important to make the correct diagnosis.

The results may be as follows:

Viral bronchitis- mucous sputum, without impurities.
Bacterial bronchitis, suspected pneumonia- the appearance of purulent impurities in the mucous discharge.
Bronchiectasis, chronic bronchitis of staphylococcal nature- completely purulent discharge.
Allergic bronchitis- a small amount of transparent secretion, in which a large number of eosinophils are detected upon microscopic examination.

When cloudy sputum settles, it usually separates into two layers, which indicates the purulent nature of the inflammation. If the liquid is stratified into three layers, this indicates the presence of a putrefactive process (a sign of incipient gangrene of the lung).

You should not independently draw conclusions about the presence of the disease only from the results of a sputum examination. It is better to entrust this to a doctor who compares them with clinical manifestations and only after that makes a final diagnosis.

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