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Cause for coughing up PHLEGM with black streaks in it.

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I have been coughing up phlegm for the last 6 months or more and not always but quite often there are black streaks or specs in it. I am attaching a photo from yesterday. I do not smoke cigarettes but am a recovering addict and alcoholic. I used to smoke crack but have not had any not at all since September of 2012 and this black stuff just started showing up that I can remember like 6-9 months ago. My blood work is normal, I am an insulin dependent Type II diabetic and as I said earlier do not drink or do any drugs, no crack since September 2012. Nothing in my chest hurts and Doctors have listened to my lungs. My question is could this still be black stuff coming out of my lungs after all this time from the crack or a sign of something else? It seems like a very long time and it has me worries. Thank you


Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Hello. Thank you for posting your query at DoctorSpring.com

Smoking, air pollution, athracosis ( coal workers disease), air pollution, fungal infection like aspergillosis etc can cause a blackish specks in sputum, as seen in the pic. it cant be said clearly when these specks stop being coughed out, once smoking is stopped. it depends on how much of smoke is inside. !
However, a gram stain examination and if necessary a giemsa stain of sputum, are relatively cheap examination i would recommend to rule out a fungal infection, especially as you are diabetic.(ps- both the tablets you are taking is for high sugar, and not cholestrol. unfortunately, still if you have a high hba1c, it means diabetes is not controlled, and you need to step up your treatment)
So to cut a long answer short, i will suggest you to do a sputum examination also, and then relax, as it might be an after effect of smoking. this in that case, is harmless and self limiting.
Feel free to discuss further,
Regards
Dr. Jacob George P
MD,FCCP


Patient replied :

Thank you Dr. you kind of confirmed what I already had found by reading on the internet, some of those fungus infections look like they can be very bad, are thye usually contagious, if it is that should my wife and children get checked? Yes I realize the Metformin and insulin I am on are for the sugar, just wondred if they could cause the black sputum. I am scheduled to go in for a chest xray tomorrow and they also gave me a sample cup to spit this stuff into the next itme it happend to get the lab to look at it. I assume by doing so they can see if it is an infection or fungus or resin or whatever from the lungs from the time when I was smoking, my question was wouldn't the bosy have cleaned out all that by now, I mean it's been close to two years? Or does it take along long time? Just curious. I guess as you said the first step is to get the chest xray and sample of the phlegm examined and then go form there, I imagine as time goes on it will clear itself if it is cleaning out all the black stuff now? Is this kind of thing in the phlegm andindicator of dried blood or a symptom of cancer or less so. I realize you have no way of knowing without the lab results but I am just curious for lung cancers what would come up red blood, black specs or something else or nothing? Thank you for all your help, and answers are helpful because i live in Estonia in Eastern Europe and am American and sometimes there is a language barrier here. Thank you Kevin Kerr


Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Hello. Thank you for posting the follow up.
Fungal infection- if present, is not contagious as you fear.So your family should be safe. It is usually seen in patients who are diabetic or other immune suppression.

The medications are not causing the symptoms. The time you stopped smoking and onset of this symptoms do not really correlate well with smoke, however its not impossible. Cancer of lungs also doesn't have such a symptom.

Awaiting the results of sputum gram stain and chest x ray.

Regards,
Dr. Jacob George


Patient replied :

I think I can ask another question. I got the lung/chest xray today and mymother in law is a GP and looked at it and said that there is some inlfamation in an area butnot much else. She feels the black specs could be being caused by my stomach. I am a little overweight, 215 pounds and 5'10" and she thinks that it is the stomach juices coming up at night and then going into the lungs and then I expectorate it in the sputum? Does this sound possible or logical. I am sending the sputum with black specs to the lab next friday for analysis. thank you


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Hello.
Let me answer your questions one by one :
I think I can ask another question. I got the lung/chest x ray today and my mother in law is a GP and looked at it and said that there is some inflammation in an area but not much else. :-
I need a lot of explanations for that simple sentence. what did she call inflammation? why did she say so? was there any pneumonia? which part of lung??/// she owes you an explanation!
She feels the black specs could be being caused by my stomach. I am a little overweight, 215 pounds and 5'10' and she thinks that it is the stomach juices coming up at night and then going into the lungs and then I expectorate it in the sputum?
For me it doesn't sound possible!. 1st thing- you should have symptoms of stomach things going into lungs- which you dont. 2nd - why should it change colour once it reaches lung? again no explanation. so i'll be waiting sputum gram stain report.
Regards
Jacob GEORGE P,
MD, FCCP, IDCCM


Patient replied :

She said that the inflamation is in the bronchi near to the heart on the left side. No sign of pneumonia and yes you're right i have no symptoms of Gurd or Acid reflux and don;t take medications for them...The culture test of the black stuff sputum I am getting done next Friday, I will send you the results then, Thank you. Kevin Kerr


Expert:  Dr. Jacob George Pulinilkunnathil replied 1 Day.

Hello.
Probably a left lower side inflammation. Well it doesnt help much, as long as there is no pneumonia.
Will await the sputum results before next move, if posible, send me a jpg image of the chest x ray also along with result of sputum.
Regards.


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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