What is the meaning of solid particles in the sputum?

Question

Dear expert team,
I (female CF patient with Pseudomonas colonization and asthma) observe for about half a year that I have in the sputum smaller to larger pinpoint particles of deep grey colour. These mostly only come out after a hard, crampy cough and occur every one to two weeks. Can this be a hint for a coming infection or for fungi?
I do daily about 5 hours of therapy with Pep, flutter, autogenic drainage and with all CF drugs (colistin, aztreonam each one month, one ampoule of rh-DNAse, budesonide and formoterole, azithromycin, salbutamol and NaCl 0,9%). Could I still inhale an additional mucolytic drug in spite of the asthma?
Many thanks for your help and regards,
S.

Answer

Hello S.,
you have in your sputum pinpoint solid particles of deep grey colour and ask for their meaning concerning your health.
Increased amounts of sputum often with brownish coloured particles can in case of CF patients be associated with the diagnosis of ABPA (allergic bronchopulmonary aspergillosis) or with an infection of fungi. The sputum particles could in such a case be fungus/ aspergillus particles. With such a changed sputum as a single symptom, however, the diagnosis of an ABPA or a fungus infection can by no means be ensured. The particles of the sputum could also be totally harmless and without any meaning.
It cannot be excluded, that it deals here with so-called tonsil stones, that take hold in the jagged tonsils and come off again.
Please contact your CF physician in charge who can bring your complaints together with the whole picture of your illness and who can initiate the respective diagnostic investigations if needed (finding of funig in the sputum?) and who decides with you, if a special therapy would be necessary.
I hope to have helped you with my answer and stay with my best regards,
Yours
Dr. med. Christina Smaczny

21.08.2014