EpistemisLaennec Pearl Sputum
Specialty: Respiratory.
Why it occurs
- Bronchial asthma in the resolution phase of an acute crisis (the bronchioles secrete a very viscous and dense mucus that adapts to the bronchial lumen; when expectorated, small spheroidal, shiny and firm masses similar to gelatin pearls appear)
- Adult asthmatic bronchitis (bronchial hyperreactivity with hypersecretion of mucus rich in eosinophils and desquamated epithelial cells)
- Allergic bronchopulmonary aspergillosis (ABPA) (hypersensitivity reaction to the fungus Aspergillus fumigatus with dense mucoid impaction and expulsion of pearly or dark bronchial casts)
- Bronchiolitis obliterans with organizing pneumonia (BONO) in the initial stages (mucinous and bronchiolar cellular exudate)
Initial workup
Forced spirometry with bronchodilator test (evaluate reversible airflow obstruction); Determination of eosinophils in sputum and peripheral blood; Quantification of total and Aspergillus-specific immunoglobulin E (IgE); Chest x-ray (to rule out lobar atelectasis due to mucosal plugging or migratory infiltrates).
red flags
Worsening dyspnea with audible wheezing at a distance, silent chest on auscultation (absence of respiratory sounds due to diffuse and severe bronchial obstruction due to mucus plugs), inspiratory muscle fatigue, or inability to cough forcefully due to physical exhaustion.
Standard management
- Fluticasone — propionate, inhaled corticosteroid, dose of 250-500 micrograms every 12 hours to reduce bronchial eosinophilic inflammation
- Salmeterol — long-acting beta-2 agonist, 50 micrograms inhaled every 12 hours associated with corticosteroids
- Prednisone (0.5 mg/kg/day orally for 5-10 days in case of moderate-severe asthma attack that occurs with mucus impaction).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3