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Updated: Nov 30, 2025
Methodology for Sputum Induction and Laboratory Processing
Published on: December 17, 2017
Sputum characteristics and airway clearance methods in patients with severe COVID-19
Yu Wang1, Meng Zhang2, Yan Yu2
1Department of Neurosurgery Intensive Care Unit.
Insights
Sticky sputum in elderly COVID-19 patients may signal critical illness. Early use of expectorants like ambroxol and prone-position drainage may improve outcomes for coronavirus disease 2019 patients.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Critical Care
Background:
- Coronavirus disease 2019 (COVID-19) poses a high fatality risk, especially in critically ill patients.
- Airway viscous secretions are noted in COVID-19 autopsies, but their characteristics and impact on prognosis are understudied.
- Identifying early warning signs and effective interventions for COVID-19 progression is crucial.
Purpose of the Study:
- To analyze sputum characteristics in COVID-19 patients.
- To investigate the relationship between sputum properties and disease severity.
- To evaluate the effect of sputum management strategies on COVID-19 prognosis.
Main Methods:
- Retrospective analysis of clinical data from COVID-19 patients.
- Classification of sputum based on viscosity (Grade 3 sticky sputum).
- Comparison of sputum characteristics and treatment interventions between critically ill and non-critically ill groups.
Main Results:
- Elderly COVID-19 patients showed higher susceptibility to critical illness (P=.024), lymphopenia (P=.035), and increased neutrophils (P=.019).
- Critically ill patients had a higher proportion of Grade 3 sticky sputum compared to non-critically ill patients (P=.026).
- Higher application rates of ambroxol (P=.043) and prone-position drainage (P=.037) were observed in patients with good prognoses.
Conclusions:
- Changes in sputum characteristics, particularly Grade 3 sticky sputum, may serve as an early warning sign for critical COVID-19 progression.
- Early administration of high-dose ambroxol and prone-position drainage may help prevent progression to critical illness and improve outcomes in COVID-19 patients.
Abstract:
Critically ill patients with coronavirus disease 2019 (COVID-19) have a high case fatality rate. Hence, controlling the disease progression of severely ill COVID-19 patients to avoid the development of severe-to-critical COVID-19 is the most important target of COVID-19 treatment. The latest autopsy results of COVID-19 patients have shown the presence of viscous secretions in the airways. However, no studies are available that specifically describe and analyze the sputum characteristics and the effects of various sputum drainage methods on the prognosis of COVID-19 patients. In our study, we found that elderly COVID-19 patients were more susceptible to progression to critical illness (P = .024) and were likely to have accompanying lymphopenia (P = .035) or increased neutrophil counts (P = .019). We observed that there was a higher proportion of patients with Grade 3 sticky sputum in the critically ill group than in the noncritically ill group (P = .026), suggesting that changes in sputum characteristics may be one of the early warning signs of critical COVID-19. In addition, we found that the application rates of large doses of ambroxol (P = .043) and prone-position drainage (P = .037) were relatively high in COVID-19 patients with good prognoses, suggesting that the early application of large doses of expectorant drugs and prone-position drainage in COVID-19 patients may avoid progression to critical illness and improve the prognosis.
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