Is phlegm a sign of COVID?

Medically reviewed: 3, January 2024

Phlegm with coronavirus: is there phlegm with covid? Does it happen with blood? Features, treatment

By the quality and quantity of phlegm in COVID-19 or coronavirus, one can judge the stage and severity of the infectious and inflammatory process. Its absence usually indicates an acute course of the pathology, a decrease in the functional activity of the respiratory tract. There are different colors of COVID-19 phlegm – green phlegm, yellow, mixed with blood.

But the separation of a greenish mucous secretion does not at all indicate an impending recovery. With a high degree of probability, coronaviruses entered the lungs, the situation was complicated by the addition of a secondary bacterial infection.

The characteristic of the phlegm discharge

Phlegm is a pathological secretion of the tracheobronchial tree that is detachable during expectoration. It is a thick, viscous mucus with an admixture of saliva and fluid produced by the lining of the nasal cavity and its paranasal sinuses. It differs significantly from the normal secretion of the tracheobronchial tree produced by the glands of the large bronchi.

Phlegm, which is constantly present in the respiratory tract of a healthy person, performs the following functions:

• delays and neutralizes infectious agents, including coronaviruses;
• prevents dust particles from entering the respiratory tract.

Normal mucus is transparent and contains macrophages and lymphocytes – cells responsible for the body’s immune response. After the introduction of coronaviruses, its qualitative and quantitative composition changes. The phlegm thickens, is firmly attached to the walls of the nasopharynx, trachea, larynx, bronchi. Now it has few immune cells, but a lot of foreign impurities:

• pathogens;
• decay products of tissues formed during the acute course of the inflammatory process;
• desquamated epithelial cells;
• blood components.

The color of the tracheobronchial secretion changes. The color of the coughing up phlegm depends on the nature of the impurities. It may contain streaks of blood, pus.

Phlegm color is an important diagnostic feature that allows you to establish the stage of the inflammatory process in coronavirus infection.

Cough without phlegm with coronavirus

60-70% of people infected with coronavirus have only a dry cough at the initial stage. It is not accompanied by sputum discharge, and there is no physiological value of it. Patients complain to the doctor about difficulty breathing, which becomes wheezing.

A dry cough does not give a person the opportunity to cough up productively, the voice becomes rough and hoarse due to the developed inflammatory edema in the throat.

Against the background of narrowing of the airways, severe shortness of breath, dizziness occurs. With coronavirus, poor sputum separation is complicated by the following symptoms:

• an increase in temperature;
• excruciating pain when trying to cough up, sore throat;
• congestion in the sinuses;
• general malaise, fatigue, weakness.

The main reason for this cough is the penetration of coronaviruses into the body. In the course of their vital activity, they produce toxic substances that cause inflammation and swelling of the mucous membranes of the respiratory tract.

Even with a dry, tearful, barking cough, there is still phlegm. It is a sticky mass firmly adhered to the walls of the respiratory tract. Epithelial cilia also stuck together, so their functional activity has significantly decreased. They are no longer able to fully clean the surface of thick, sticky mucus.

Doctors studying the new coronavirus noted its selectivity. Pathogens prefer to invade those cells on the membranes of which special receptors are located. They are equipped mainly with the nasal passages and alveoli of the lungs. This explains the absence of inflammation in the bronchi and trachea in acute or subacute coronavirus infection.

Patients suffer from bronchiolitis or alveolitis, and extremely rarely – bronchitis or tracheitis.

Doctors explain the scanty phlegm discharge in coronavirus and the localization of foci of pneumonia. They are usually formed closer to the outer surface, next to the pleural membrane, which makes it difficult to cough productively.

Coughing up phlegm and coronavirus

In about a third of patients with coronavirus, it immediately manifests itself as a wet cough, in which sputum leaves. This is a reflexive defense reaction of the body that helps to clear the respiratory tract. But doctors have found that most often a wet cough occurs in people with initial lesions of the respiratory system. In the process of replication, coronaviruses release toxic products of their vital activity into the surrounding space.

Their spread throughout the body provokes an exacerbation of chronic bronchopulmonary pathologies.

Also, a wet cough was noted in such groups of patients:

• smokers;
• predisposed to the development of allergic reactions.

In most infected people, phlegm begins to drain after taking medications to thin it. The viscosity of the bronchial secretion decreases, and its evacuation from the respiratory tract is accelerated. Thick mucus, firmly attached to the bronchi, larynx, pharynx, liquefies.

At the same time, inflammatory edema, which obstructed air circulation, is resolved. The mobility of the cilia covering the epithelium also increases. Recovery is also accelerated by the rapid transport of coronaviruses by the mucociliary system.

Varieties of phlegm in cough

The fact that an adult or a child is recovering is indicated by the separation of clear phlegm. If it leaves with difficulty with a hasty cough, is painted in any color, smells unpleasant, then there is a high risk of complications. You should immediately inform the doctor about the appearance of such a mucous secretion.

Phlegm with blood

Impurities of fresh blood in phlegm during coronavirus infection are extremely rare. Rare dark brown blood streaks are usually observed, which is a specific sign of severe damage to the lower respiratory tract by pathogenic bacteria. Conditionally pathogenic microbes that are already present can be activated against the background of a weakening of immunity, or pathogens enter the body from the outside.

Under the influence of the toxins they produce, the permeability of the vessels that feed the pulmonary structures with blood increases.

This is almost always accompanied by the following symptoms:

• febrile condition, chills;
• shortness of breath;
• chest pain.

If, when coughing up, scanty phlegm with blood streaks, impurities of fresh blood is released, then pneumonia has either developed or will appear very soon.

 

With a mixed viral-bacterial infection, when coughing up, a brown mucopurulent pneumonia is separated on days 2-3. CT scan clearly visualizes the “ground glass” effect – a nonspecific symptom reflecting various pathological changes in the lungs at the level of the alveoli.

Green phlegm in COVID-19

Abundant or scanty green phlegm in COVID-19 is a warning sign of damage to the upper and lower respiratory tract. It is not always a direct symptom that you have a COVID-19 if you are coughing up green phlegm. This is rather a sign that a large number of pathogenic bacteria have entered them: staphylococci, streptococci, pneumococci. The green color of thick mucus is explained by the presence of dead pathogenic microorganisms and products of an acute infectious and inflammatory process in it.

As a rule, when a viscous greenish-brown sputum passes, a person with coronavirus is immediately hospitalized. Intensive antibiotic therapy is needed to prevent bacterial pneumonia. A cough with green phlegm is often associated with additional symptoms:

• high fever;
• shortness of breath;
• loss of strength.

Before starting treatment, a number of biochemical studies will be carried out to establish the species of infectious pathogens and their sensitivity to antibiotics. To exclude oncological pathologies, thoracoscopy is performed.

Yellow phlegm with COVID-19

Yellow phlegm is not always a symptom of COVID-19, it also indicates the presence of pathogens in the body and often indicates the onset of a lung abscess. This is the name of nonspecific inflammation of the lung tissue, as a result of which melting occurs with the formation of purulent-necrotic cavities.

Severe pathology is characterized by discharge of yellowish fetid sputum during the breakthrough of an abscess into the draining bronchi. And it always happens suddenly – a dry cough is rapidly replaced by a wet one, followed by the expectoration of a large volume of liquid purulent discharge “with a full mouth.”

After sputum discharge, the state of health quickly improves, body temperature normalizes, signs of intoxication disappear. But medical intervention is vital. Treatment is mainly medication – antibiotics, expectorant drugs, bronchodilators and hormones. Surgical operations can be performed according to indications.

COVID-19: How to speed up phlegm excretion?

The use of syrups, tablets, pills, lozenges for sucking will allow you to start to expectorate productively. In the treatment of coronavirus infection, the following groups of drugs are used:

• mucolytics – Ambroxol, licorice extracts, marshmallow, for example, Mukaltin. Necessary to dilute sputum with strong adhesion of thick, dense secretion to the mucous membranes of the respiratory tract;
• mucokinetics – Bromhexine and analogues. They help to activate the ciliated epithelium during productive sputum to accelerate its discharge from the respiratory tract.

The use of antitussive drugs is rarely practiced. They only alleviate the patient’s condition with a dry, barking cough by affecting the cough center. If a bacterial infection is suspected, antibiotics are included in treatment regimens – macrolides, semi-synthetic penicillins protected by clavulanates, lincosamides, cephalosporins.

Antiviral drugs are almost never used, since many lack the evidence base for therapeutic efficacy.

With coronavirus, doctors do not recommend thinning phlegm with inhalation, since an aerosol saturated with viral particles will form in the air.

The accumulation of sputum in the respiratory tract with coronavirus becomes a favorable environment for the growth and reproduction of pathogenic bacteria and pathogenic fungi. Infectious foci are formed, from which microorganisms are carried by the blood stream to the internal organs. Therefore, from the first days of treatment, doctors prescribe drugs with mucokinetic and mucolytic effects to patients.