Normal airways produce mucous. The mucous lines the airway’s surface to trap air borne particles, viruses, bacteria, and fungi. This trapped material, within a small amount of mucous, will be transported up the airways by the cilia, to be swallowed. The mucous also keeps the airways hydrated.
Diseases of the lungs produce abnormal looking mucous which is called sputum or phlegm.
Describing accurately your sputum will help your doctor come to an accurate diagnosis of your lung condition.
It is a good practice to take a photo of the sputum which you have coughed out to show to your doctor. A picture of the sputum is worth a thousand words.
Note the volume of the sputum. It can be a little, or copious, like half a cupful. Some patients with extensive bronchiectasis produce a large volume of sputum every day.
Note the viscosity of the sputum. Sputum which is fluid or watery can be coughed out easily. Sputum which is viscid or thick can be difficult to cough out. A bout of severe cough can worsen breathlessness and may cause a person to faint. Mucolytics can be taken orally to reduce the viscosity of the sputum making it more fluid to be coughed out.
Next note the colour of the sputum.
Healthy airways produce mucous which is fluid and clear.
Whitish sputum is somewhat thicker and cloudier. A viral infection may cause the sputum to be white in colour.
Yellow coloured sputum contains white blood cells, particularly neutrophils and eosinophils. These cells are present at the site of inflammation, like in asthma, or in bacterial infection.
Green coloured sputum has a higher concentration of white blood cells which are involved in fighting an infection caused by bacteria.
During an active infection, there is activation of the host defence mechanism which results in neutrophil recruitment in the airways, to kill the bacteria. This neutrophil influx is associated with a change in nature of the airway secretions from mucoid to purulent looking.
The release of myeloperoxidase from the neutrophils, during the killing of the bacteria, is what makes the sputum green. When the bacterial load is reduced or eliminated with antibiotic therapy, there is resolution of the secondary host defence response, and the colour of the sputum will return back to normal or white in colour.
Red coloured sputum denotes the presence of blood. During active airway bleeding, the colour of the sputum freshly coughed out is bright red. When the airway bleeding has stopped, the sputum will contain stale blood which is dark red in colour.
Sputum with brown and black specs within, commonly come from smokers or mine workers.
It is very important for patients with chronic lung diseases to note their usual sputum colour, which may not be normal, even when their diseases are in a stable condition. Things to note are cough frequency, sputum characteristics, level of breathlessness during daily activities and other constitutional symptoms like fever, fatique, tiredness, appetite and sleep.
During an acute exacerbation of COPD, following a viral or bacterial infection, a patient will experience more cough, increasing sputum volume with change in sputum colour and increasing shortness of breath, perhaps with wheezing. Noticing these worsening symptoms, the patient should seek medical advice immediately.
Your doctor may ask for your sputum to be collected. At times, three consecutive specimens, on different days, maybe required.
The best time to collect your sputum is in the morning. Gargle and rinse your mouth with water before collecting the specimen. This helps to eliminate prior, accumulated cells and bacteria in your mouth that may interfere with test results.
You may wish to perform the huff manoeuvre to bring phlegm up to the upper airways to be coughed out and collected.
The sputum specimen, about 5 ml or more, must be put into a sterile container which are available from clinics or laboratories.
Please remember to collect sputum and not spittle, which contains mainly saliva.
The specimen is best sent to the lab within 2 hours of collection.
Mr Chin Yoong Kim was a geography and music teacher in ACS Ipoh. He was very passionate about teaching and taught geography with great enthusiasm. He would bring along those large foldable maps to class to illustrate the teaching points and to make his lessons interesting. His classes were usually very informal where questions would come from both sides, the teacher and his students.
His huge interest in geography and how local conditions affected peoples' livelihoods brought him to visit Leong Sin Nam Farm. He was interested to investigate how pomelos grew and how pigs were reared. During the visit several of us had great difficulty getting on the plastic covers over our shoes to prevent farm contamination. Fortunately, none of us slipped and fell into a pig stye!
I had the privilege of being his Form 4 Science A Class Monitor in 1972 with Wai Hoong as assistant. During a class photo shoot, I remembered him asking me why I was still in shorts rather than in longs. He wasn't angry as it was only a small matter and we laughed it off. But certainly the photo turned up okay as above without any details of hairy legs. Surely, all of us look younger and sportier in shorts!
As you can see in this photo above, we had in class some of the most mischievous people around in school. We were usually the noisy lot and Mr Yoong Kim would have this funny way of addressing us as "yooooou creatures"!
Mr Yoong Kim was such a friendly and approachable teacher. We always invited him to our class social functions. He would dance, laugh and joke with all of us. He was also such a gentleman whom all other teachers can easily associate and relate. These pictures were taken in 1975.
Mr Yoong Kim would invite all of us to his bungalow at Jalan Khong Kam Tak every Chinese New Year. We felt very much at home in his home and whatever goodies he had in his refrigerator were ours too.
Mr Yoong Kim had great passion for music and school stage plays. His favorite warm up songs were "Tiny Bubbles" and "Pearly Shells". I was not in the school choir nor in his musical productions, but did acquire some singing tips from him during school assemblies.
Here are some of his singing tips. Use abdominal breathing to get more air into the lungs. Relax the throat and tongue muscles and the voice must come out from at the vocal cord level. Let the musical notes vibrate in the oral cavity to create a natural unique sound.
After leaving ACS, I met Mr Yoong Kim on several occasions. We had some sharing during his Rotary Club meetings at the Royal Ipoh Club, when I was a guest speaker on several occasions. Mr Yoong Kim was once the President of the Rotary Club of Ipoh.
Below are two pictures of Mr Yoong Kim during the ACS Alumni Dinner in 1999. He was very involved in the ACS Ipoh Alumni Association and the Perak Society of Performing Arts. He was also once in-charge of the Canning Garden Methodist Church choir.
One can never forget his style of getting all the attendees jazzed up before the singing of the ACS School Song in every ACS Alumni Dinner.
Mr Yoong Kim had been a great teacher to many students. I must surely salute his humble demeanor and his willingness to help others.
Mr Chin passed away on Wednesday 16th November 2022. May the good Lord continue to bless him and keep him. Rest in peace dear Sir.
