Pope Francis had two acute respiratory crises on Monday, the Vatican said, stoking further concerns about the health of the 88-year old pontiff, who has been hospitalized in Rome in serious condition for more than two weeks.

The pope has been undergoing treatment for double pneumonia and a complex infection in a Rome hospital, and his condition has been alternating between improvements and setbacks. On Friday, Francis suffered another bronchial spasm that caused him to inhale his vomit after a coughing fit.

The Vatican said that Monday’s episodes were caused by a significant accumulation of mucus in his bronchial tubes as a consequence of pneumonia. Doctors examined the inside of the pope’s lungs, and then suctioned abundant secretions of mucus, the Vatican said.

The Vatican said in a statement that “The Holy Father has remained consistently alert, oriented, and cooperative.”

The pope’s medical prognosis remained guarded, implying that he was not out of danger.