Unusual Symptom: Coughing Up Sputum That Settles into Three Layers

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Coughing up sputum is a common thing but coughing up sputum that settles into three layers is very unusual. Copious purulent sputum production that settles into three layers when expectorated into a receptacle is characteristics of bronchiectasis. This sy

Copious purulent sputum production that settles into three layers when expectorated into a receptacle is characteristics of bronchiectasis.

The following are the possible etiologies when you cough up sputum that settles in three layers:

Bronchiectasis /prior to lung infection (e.g., prior necrotizing pneumonia, viral fungal)

Cystic fibrosis

Alpha-1 antitrypsin deficiency

Inhalation injury

Kartegener’s syndrome



The chronic production of excessive purulent, foul-smelling sputum that settles into three layers is characteristic of bronchietasis. Bronchiectasis is defined as permanent bronchial dilatation resulting from destructive inflammatory changes within the elastic and muscular walls of the bronchi. Bronchiectasis may be confined to one lung segment or be  diffuse in nature, affecting most portions of the lungs.  The most common etiologies of bronchiectasis are prior pulmonary infection with various viruses or bacteria that results in significant bronchial destruction.  Other noninfectious etiologies may be responsible as well. As a result of chronic inflammation and bronchial damage, the mucociliary clearance mechanisms of the lung are affected, which leads to pooling of excess secretions that then become secondarily infected, resulting in increased purulent sputum production. Patients with bronchiectasis not uncommonly present during adulthood with chronic cough, hemoptysis, fever, and weight loss that result from chronic bacterial superinfection, often with gram-negative bacteria. The classic symptom is copious production of purulent, foul-smelling sputum that may approach volumes of 500 cc per day. A characteristic, but uncommon, symptom of bronchiectasis is patients’reporting that their sputum settles into three distinct layers if they expectorate it into a cup or other receptacle. The three layers consist of a frothy top layer that consists of watery saliva; middle mucoid layer consisting of glandular mucus; and a bottom purulent layer.  Patients suspected of having bronchiectasis based on history should undergo chest radiography and, if indicated, high resolution computed tomographic scanning of the chest to assess the severity. Antimicrobial therapy is often administered to control acute infectious exacerbations in patients with bronchiectasis, although some patients may require chronic suppressive therapy.

The coughing up sputum usually happens early in the morning after waking up.  Due to less activity of the mouth and snoring during sleep, sputum is developed in the lower airways of the throat. Sputum is mucus that is formed at the lower airways of the throat. It is usually useful for medicinal investigation on microorganisms that are present in the respiratory system of the body. It a patient coughed up with a sputum with three layers, as described above, this is a sign of a severe illness in the respiratory system basically the throat or the lungs that should be diagnose as soon as possible before the illness worsens. 

Here are other unusual symptoms:

Unusual Symptom: Coughing Up a "Stone"

Unusual Symptom: Blood in the Semen

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Posted on Jul 14, 2012