Bronchiectasis: Recognizing Cough, Excess Mucus, and Shortness of Breath for Timely Intervention

Living with a chronic respiratory condition like bronchiectasis can significantly impact daily life, especially when symptoms such as persistent coughing, excessive mucus production, and breathlessness emerge. Early recognition and prompt medical care are essential to managing flare-ups and preventing complications such as respiratory failure. This case study explores the journey of a 60-year-old male patient who experienced an acute exacerbation of bronchiectasis triggered by a cold, highlighting the importance of timely diagnosis, comprehensive treatment, and long-term management strategies.

Patient Overview and Diagnosis

Age & Gender: 60-year-old maleMedical History: Over 20 years of diagnosed bronchiectasis with recurrent episodes of cough and sputum productionHospital: Renmin Hospital of Wuhan UniversityDate of Admission: April 2022Diagnosis: Bronchiectasis with infection and acute-on-chronic respiratory failure

The patient presented with a four-day history of worsening symptoms following exposure to cold weather. He reported a persistent morning cough producing large amounts of yellow-green purulent sputum. Physical activity or exertion led to chest tightness and shortness of breath. Intense coughing episodes caused left-sided chest pain, and he occasionally felt palpitations. Notably, there was no fever or night sweats. On examination, he appeared thin with cyanosis (bluish discoloration) of the lips and mild tachypnea—rapid breathing—especially when speaking quickly.

Initial Clinical Assessment

Given his long-standing respiratory issues, the clinical team prioritized identifying signs of infection and respiratory compromise. A high volume of thick, discolored sputum is often indicative of bacterial colonization or infection in patients with structural lung disease. The presence of exertional dyspnea and cyanosis raised concerns about impaired gas exchange, pointing toward possible respiratory failure.

Diagnostic Workup and Confirmation

To confirm the diagnosis and assess severity, a series of diagnostic tests were performed:

• Chest CT scan: Revealed characteristic findings of bronchiectasis—dilated, thickened airways with surrounding inflammation.
• Arterial blood gas (ABG) analysis: Showed hypoxemia and hypercapnia, confirming type II respiratory failure.
• Blood tests: Elevated white blood cell count and procalcitonin levels indicated active bacterial infection.
• Lung function tests: Demonstrated obstructive pattern with reduced diffusion capacity.
• Liver and kidney function panels: Within normal limits, allowing safe use of antibiotics.

Based on clinical presentation and imaging results, the final diagnosis was confirmed: bronchiectasis with acute infective exacerbation and secondary respiratory failure.

Comprehensive Treatment Approach

A multi-modal treatment plan was implemented to address both immediate symptoms and underlying pathophysiology:

Oxygen Therapy for Respiratory Support

The patient received supplemental oxygen via nasal cannula to correct hypoxia and reduce the work of breathing. Continuous monitoring ensured oxygen saturation remained above 90%, helping prevent further strain on the heart and lungs.

Endobronchial Suctioning via Bronchoscopy

Due to retained secretions obstructing the airways, a bronchoscopy was performed under local anesthesia. This procedure allowed direct visualization of the bronchial tree and effective removal of thick mucus plugs, immediately improving airflow and reducing infection burden.

Antibiotic Regimen for Infection Control

A dual antibiotic approach was chosen based on suspected pathogens common in bronchiectasis:

• Ceftazidime: A broad-spectrum cephalosporin effective against Gram-negative bacteria like Pseudomonas aeruginosa.
• Moxifloxacin sodium chloride solution: A fluoroquinolone with strong lung penetration and coverage against atypical organisms.

Secretion Management and Airway Clearance

Intravenous ambroxol: Used to enhance mucociliary clearance by reducing sputum viscosity.Neubulization therapy: Administered three times daily using a mixture of:

• Budesonide suspension (anti-inflammatory corticosteroid)
• Ipratropium bromide (bronchodilator)
• Acetylcysteine solution (mucolytic agent)

Treatment Outcomes After 10 Days

After one week of intensive in-hospital care, significant improvements were observed:

• Dramatic reduction in cough frequency and sputum volume
• Resolution of cyanosis; lip color returned to normal
• Restored regular breathing rhythm without distress
• Follow-up ABG showed normalized oxygen and carbon dioxide levels
• Inflammatory markers (WBC, procalcitonin) dropped to near-normal ranges
• Improved exercise tolerance—able to walk short distances without breathlessness

By day 10, the patient was clinically stable and discharged with a clear follow-up plan. His quality of life had markedly improved compared to admission.

Key Recommendations for Long-Term Management

While hospital treatment addressed the acute crisis, long-term success depends on proactive self-care and lifestyle adjustments. Here are essential guidelines for patients living with bronchiectasis:

1. Prioritize Rest and Avoid Triggers

Overexertion and stress can worsen symptoms. Patients should maintain a balanced routine that includes adequate sleep and relaxation. It's crucial to avoid cold air, cigarette smoke, pollution, and other respiratory irritants that may trigger flare-ups.

2. Optimize Nutrition for Immune Support

A nutrient-dense diet plays a vital role in recovery and prevention. Focus on:

• High-protein foods (lean meats, eggs, legumes)
• Vitamin-rich fruits and vegetables (especially vitamin C and antioxidants)
• Hydration: Drink at least 1.5–2 liters of water daily to keep mucus thin and easy to expel

3. Engage in Regular Aerobic Exercise

Controlled physical activity such as walking, light jogging, or pulmonary rehabilitation exercises strengthens respiratory muscles, improves lung capacity, and boosts immunity. Even 20–30 minutes per day can make a meaningful difference over time.

4. Practice Effective Airway Clearance Techniques

Post-discharge, patients should continue daily techniques to clear mucus:

• Controlled coughing techniques
• Deep breathing exercises
• Use of positive expiratory pressure (PEP) devices if prescribed
• Regular use of prescribed inhalers or nebulizers

Understanding Bronchiectasis: A Chronic but Manageable Condition

Bronchiectasis develops when chronic inflammation damages the walls of the bronchial tubes, leading to irreversible dilation and loss of elasticity. This structural change impairs the lungs' ability to clear mucus, creating a cycle of infection, inflammation, and progressive lung damage.

Common symptoms include:

• Chronic productive cough with copious sputum
• Recurrent pneumonia or bronchitis
• Occasional hemoptysis (coughing up blood)
• Fatigue and declining stamina

While there is no cure, early intervention during exacerbations—such as aggressive antibiotic therapy, airway clearance, and anti-inflammatory support—can halt progression and preserve lung function.

Final Thoughts: Prevention Is Key

This case underscores the importance of vigilance among individuals with pre-existing lung conditions. Any new or worsening respiratory symptom should prompt immediate medical evaluation. With proper education, consistent treatment adherence, and healthy lifestyle choices, patients with bronchiectasis can lead fulfilling lives and minimize hospitalizations.

Early detection, personalized treatment plans, and ongoing patient engagement form the cornerstone of successful long-term outcomes in bronchiectasis care.