Yellow-Green Phlegm and Other Myths

MYTH: Everyone knows that if you have a head cold, your sinuses are congested and painful, you are bringing up thick yellow or green mucous, you have a sinus infection and need antibiotics, right? NOT!

MYTH: Everyone knows that if you have a prolonged chest cold, are coughing up the same sort of yellow or green stuff, it is bronchitis and you need antibiotics, right? NOT!
These are two major examples of myths health care providers and patients have perpetuated that have contributed strongly to antibiotic overuse in the past. As a result, these same antibiotics are now less effective against some common bacteria.

FACT: Viral upper respiratory illness (URI) is characterized by clear thin mucous from the nose or back of the throat for the first phase of the illness (usually one to three days). After that the mucous that is produced starts to thicken and often turns yellow or green as the body responds to the virus. THIS IS THE NORMAL SEQUENCE OF EVENTS. People may actually feel worse during this phase because their sinuses are not able to drain as well. As a result, facial pain and pressure may be more prominent and this is commonly thought of as a sinus infection.

This is all part of the viral infection and it should be treated with decongestants (pseudoephedrine or Sudafed), Tylenol or Advil, and additional fluids to maintain moisture in bodily secretions. Inhaling the steam from hot tap water or boiled water can also be very effective, if done with care. There are decongestant nasal sprays (Afrin, others) available in pharmacies that can be very effective, as long as they are used regularly only for 48 hours or less and then no more than once a day, usually at night. Otherwise they can cause a rebound effect, which actually increases nasal congestion and further obstructs nasal breathing.

These remedies are also useful for the ear pressure that commonly occurs when the nose and sinuses are congested. While sometimes a persistently painful ear can be a sign of an infected eardrum and antibiotics may be needed, most commonly the ear pressure can be effectively treated with the above remedies and a bit of TOT (Tincture of Time). If you have to travel by plane while suffering from head or ear congestion, use an oral decongestant plus nasal decongestants sprayed into the nose shortly before take off. This can sometimes help prevent the severe ear pain that can develop when lowered atmospheric pressure is added to already congested eustachian tubes.

In the same way that URIs cause nasal, sinus and ear congestion, they can cause a viral bronchitis characterized by coughing up yellow or green material, which can be quite persistent, and sometimes hoarseness as well. This problem is much more common in smokers, who already have damaged, irritated bronchial tubes, and sometimes in people with asthma and allergies.

The treatment for this is less than satisfactory and although sometimes the same techniques used to treat nose and sinus congestion can be effective, many times these measures dry out bronchial secretions and make them harder to cough up. The trick here is in helping the body actually cough up whatever mucous is present for as long as it takes. Although a persistent cough is one of the most annoying and frustrating symptoms known to man, it is this cough reflex that is the body’s important defense mechanism in keeping these secretions from getting blocked in the lung tissue and causing pneumonia. Rather than trying to suppress coughing, which seldom is effective anyway, treatment should be aimed at helping the body cough up whatever phlegm is being produced, which is the only way the cough will eventually stop.

Increase your fluid intake, rest, stop smoking, and inhale steam as mentioned above. Although plain Robitussin can be helpful as a means of thinning out this thick mucous, the required dose is more than what is recommended on the bottle. Two tablespoons (1 oz) four times a day is felt to be an effective dose and can be tried. The point is that antibiotics are totally ineffective in this situation since they are not effective against viruses.

Will antiobiotics work?
If antibiotics are ineffective against the symptoms of URIs, why have they been prescribed so often and continue to be prescribed for viral infections? There are probably two reasons. We are an extremely impatient society and most of us have little ability to treat symptoms by the measures I have discussed, if we think there is some miracle drug that will cure us in 24 hours. (After all, why do we play the lottery?) Also providers over the years have not had the patience, or sometimes the knowledge, to explain these things to patients and it has always been faster and easier to prescribe an antibiotic prescription for a problem that will get better on its own just with time. Yet it is clear that antibiotics will continue to become less effective if we continue to use them freely for infections which do not need them, and for which they were never intended.


The information provided above is for educational purposes only.  Please do not use this information to diagnose yourself.  If you have further questions or concerns about this topic or any others, please contact a Campus Health Service provider at (520) 621-9202.