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Abstract: In this case, a 67-year-old patient presented with cough symptoms after exposure to cold, coughing yellow-green pus sputum with chest tightness and dyspnea. The patient indicated that she had bronchiectasis and emphysema, which are common clinical lung diseases, and after completing relevant examinations, she was immediately treated with symptomatic supportive therapy such as active anti-infection, sputum chemotherapy, wheezing and bronchoscopic sputum drainage, etc. The symptoms of cough, sputum and dyspnea were significantly relieved and her condition gradually improved.
Basic information】Female, 67 years old
Disease Type】Bronchiectasis
Hospital】Wuhan University People’s Hospital
Date of Consultation】May 2022
Treatment plan] Aspiration therapy (bronchoscopic aspiration) + intravenous injection (ceftazidime tazobactam sodium for injection (5:1), moxifloxacin hydrochloride injection, picrotoxin brain injection) + nebulized inhalation (budesonide suspension for inhalation, compound ipratropium bromide solution for inhalation)
[Treatment period] 12 days of hospitalization and outpatient follow up
Treatment effect】The patient’s condition improved significantly, and the inflammation indexes all returned to normal.
I. Initial consultation
The patient is a 67-year-old female who complained of recurrent coughing after exposure to cold for the past 3 years, with a pronounced cough in the morning, yellow-green sputum and a large amount of sputum, accompanied by chest tightness and wheezing discomfort, occasional panic attacks, no other discomfort such as fever and night sweats, and obvious wet rales could be heard in both lungs on auscultation. He had a chest CT examination showing bronchial dilatation and emphysema, and was treated with intermittent infusion in our outpatient clinic several times, but his symptoms improved and then he had another attack. The patient had a history of bronchiectasis for 7 years, with cough and sputum symptoms occurring from time to time, and her mobility had decreased compared with the previous period.
II. Treatment history
The patient had bronchiectasis and was admitted to the hospital with a cough and yellow-green pus sputum. Immediately, he completed routine blood tests, C-reactive protein, calcitoninogen, chest CT, sputum culture, and pulmonary function tests, which showed an increase in leukocyte and neutrophil counts. The patient was given ceftazidime tazobactam sodium for injection (5:1) and moxifloxacin hydrochloride injection as anti-infection according to the drug sensitivity test, together with pseudomonas aeruginosa injection to relieve coughing symptoms.
III. Treatment effect
After active treatment with suction, intravenous injection and nebulized inhalation, the patient’s cough and sputum symptoms were reduced, yellow pus sputum was changed to white sputum, and the sputum volume was significantly reduced, and no obvious wet rales were heard on both lung auscultation. The patient was discharged after 12 days of hospitalization, and was advised to pay attention to the outpatient follow-up.
IV. Notes
We are glad that the patient’s condition improved after treatment, but patients with bronchiectasis should quit smoking as soon as possible, pay attention to rest, avoid cold and flu, avoid contact with cold air, and strengthen nutrition by eating a high-protein diet of meat, eggs, milk, fish, etc., and enhance physical fitness with appropriate exercise, including brisk walking and jogging. At the same time, long-term use of phlegm medication to promote the excretion of phlegm can effectively prevent the occurrence of lung infections and slow down the deterioration of lung function. If patients with bronchiectasis develop cough and cough yellow pus sputum, active anti-infection, sputum chemotherapy and symptomatic treatment should be carried out according to sputum culture, drug sensitivity or empirical medication.
V. Personal insight
In this case, respiratory tract infection was caused by cold. Long-term, chronic respiratory tract infection can cause destruction, edema, thickening, scarring, and distortion of the bronchial tube wall, which can lead to irreversible dilatation. Bronchial dilatation is structural lung and generally causes irreversible damage to lung function. Typical symptoms of bronchiectasis include chronic cough, coughing up large amounts of purulent sputum and recurrent hemoptysis. Patients with these symptoms need aggressive anti-infection, sputumification and symptomatic treatment to keep airway drainage open.