Managing Bronchiectasis in a 67-Year-Old Patient: The Critical Role of Avoiding Cold Exposure

Disclaimer: This article is intended solely for educational and informational purposes. To protect patient privacy, all personal and medical details have been anonymized and appropriately modified.

Overview: Understanding Bronchiectasis and Its Management

Bronchiectasis is a chronic respiratory condition characterized by the abnormal widening of the bronchial tubes, leading to persistent cough, excessive mucus production, and recurrent lung infections. In this case, a 67-year-old female developed worsening symptoms following exposure to cold temperatures. She presented with a persistent cough, production of thick yellow-green sputum, chest tightness, and shortness of breath—classic signs of an acute exacerbation of bronchiectasis complicated by underlying emphysema. After comprehensive diagnostic evaluation, she received targeted treatment including antimicrobial therapy, airway clearance techniques, nebulized medications, and bronchoscopic suctioning. Her symptoms significantly improved, inflammatory markers normalized, and she was discharged after a 12-day hospital stay with plans for ongoing outpatient follow-up.

Patient Profile at a Glance

Gender: FemaleAge: 67 yearsDiagnosis: Bronchiectasis with secondary emphysemaHospital: Renmin Hospital of Wuhan UniversityDate of Admission: May 2022Treatment Approach: Bronchoscopic suctioning, intravenous antibiotics (ceftazidime-tazobactam and moxifloxacin), anti-inflammatory injections (asarone), and nebulized corticosteroids (budesonide) combined with bronchodilators (ipratropium bromide)Treatment Duration: 12 days inpatient care followed by regular outpatient monitoringOutcome: Marked clinical improvement with resolution of infection markers and reduced respiratory symptoms

Initial Clinical Assessment and Symptom History

The patient reported a three-year history of recurrent respiratory issues triggered by cold exposure. Her primary complaints included a chronic morning cough producing large volumes of yellow-green purulent sputum, accompanied by exertional dyspnea and occasional palpitations. Notably, she did not experience fever or night sweats, which helped differentiate her condition from active tuberculosis or other systemic infections. On physical examination, bilateral coarse crackles were heard upon auscultation, indicating retained secretions in the lower airways.

A prior chest CT scan had confirmed structural damage consistent with bronchiectasis and pulmonary emphysema—common findings in long-standing obstructive lung disease. Over the past seven years, she experienced multiple flare-ups requiring intermittent intravenous antibiotic treatments at the outpatient clinic. Each time, symptoms would improve temporarily before recurring, especially during colder months or after sudden temperature drops. Her functional capacity had gradually declined due to increasing fatigue and breathing difficulties during routine activities.

Diagnostic Workup and Treatment Plan

Upon admission, a full panel of diagnostic tests was conducted to assess the severity of infection and guide therapy. Blood work revealed elevated white blood cell count and neutrophilia, along with increased C-reactive protein (CRP) and procalcitonin levels—clear indicators of bacterial infection. A repeat chest CT confirmed persistent bronchiectatic changes, while sputum culture identified Pseudomonas aeruginosa, a common but potentially dangerous pathogen in patients with chronic lung diseases.

Based on sensitivity testing, a dual intravenous antibiotic regimen was initiated: ceftazidime-tazobactam (5:1 ratio) and moxifloxacin, both effective against multidrug-resistant strains of Pseudomonas. To support airway clearance, bronchoscopy was performed to suction out accumulated mucus plugs that were obstructing distal airways. This procedure not only improved ventilation but also reduced the risk of further infection.

Adjunctive Therapies for Symptom Relief

In addition to antibiotics, the patient received asarone injection to reduce mucus viscosity and promote expectoration. Nebulized therapy included budesonide—a potent corticosteroid—to decrease airway inflammation—and a combination of ipratropium bromide and albuterol to relax bronchial smooth muscle and ease breathing. These interventions were critical in managing acute bronchospasm and improving overall lung function.

Nutritional counseling was provided, emphasizing high-protein foods such as lean meats, eggs, dairy products, and fish to support immune function and tissue repair. Hydration was encouraged to thin secretions, and the patient was advised to avoid known triggers like cold air, smoke, and pollutants.

Positive Treatment Outcomes and Recovery Progress

Within days of initiating treatment, the patient showed significant improvement. Her cough became less frequent and productive, with sputum transitioning from thick yellow-green pus to clear or white mucus. Auscultation revealed a marked reduction in crackles, suggesting better airway clearance. Follow-up lab tests demonstrated normalization of white blood cell count, CRP, and procalcitonin levels. Repeat sputum cultures came back negative for bacterial growth, confirming successful eradication of the infection.

After 12 days of intensive care, she was deemed stable for discharge. Pulmonary function remained compromised due to irreversible structural damage, but symptom control was excellent. She was given detailed instructions for home care and scheduled for regular check-ups to monitor lung health and prevent future exacerbations.

Key Recommendations for Long-Term Management

While the immediate crisis was resolved, long-term management is essential for patients with bronchiectasis. First and foremost, smoking cessation cannot be overstated—even former smokers benefit greatly from quitting. Avoiding cold environments and sudden temperature changes is crucial, as these can trigger bronchoconstriction and increase mucus production.

Diet plays a vital role in maintaining immunity and energy levels. A balanced intake of protein, vitamins, and healthy fats supports lung tissue integrity and helps fight off infections. Regular physical activity, such as brisk walking, light jogging, or pulmonary rehabilitation exercises, enhances cardiovascular fitness and promotes natural mucus clearance through improved breathing mechanics.

Long-term use of mucolytic agents or daily nebulized therapies may be recommended to keep airways clear. Annual influenza vaccination and pneumococcal immunization are strongly advised to reduce the risk of respiratory infections. Any new onset of colored sputum, increased cough, or fever should prompt immediate medical evaluation to initiate early antibiotic treatment based on culture results or empirical guidelines.

Clinical Insights: Why Early Intervention Matters

This case highlights how seemingly minor environmental factors—like exposure to cold air—can precipitate severe respiratory complications in vulnerable individuals. Chronic or recurrent infections lead to progressive destruction of bronchial walls, resulting in permanent dilation, impaired ciliary function, and mucus stasis. Once established, bronchiectasis is irreversible, making prevention and early intervention paramount.

The hallmark triad of symptoms—chronic productive cough, copious purulent sputum, and recurrent hemoptysis—should raise suspicion for bronchiectasis, especially in older adults with a history of respiratory illness. Timely diagnosis through imaging and microbiological testing allows for targeted treatment, reducing hospitalizations and slowing disease progression.

Ultimately, effective management hinges on a multidisciplinary approach: combining pharmacological therapy, airway clearance techniques, lifestyle modifications, and patient education. By empowering patients to recognize warning signs and adopt protective habits, clinicians can significantly improve quality of life and long-term outcomes for those living with chronic lung conditions like bronchiectasis.