Findings of Bronchiectasis

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History and Physical Findings
The case is regarding a patient who is a 62-year-old Caucasian male, hypertensive with medications, who complains of persistent productive cough and shortness of breath that started 6 months ago. The patient’s symptoms are aggravated by doing activities and are relieved by rest. The patient experiences frequent, intermittent coughing, which is worse in the morning. The color of sputum is whitish-yellow. The patient previously tried Robitussin DM to relieve coughing, but it did not alleviate the symptoms. Currently, the patient cannot walk for >20ft without rest periods due to shortness of breath but was able to walk 1 mile per day a year ago consistently. The patient is currently on medication for hypertension, taking Metoprolol succinate ER (Toprol-XL) 50 mg daily. The patient denied alcohol consumption or illicit drug use and was previously a smoker with 20 pack years. The patient has a family history of diabetes, hypertension, and heart failure on the paternal side. Physical examination reveals that the patient does not have fever, chills, sudden weight loss, labored breathing, JVD, or lower extremity edema. He also denies chest pain. The patient is obese. Vital signs are within normal limits except his blood pressure at 156/94 mmHg and oxygen saturation at 94% on RA. Upon auscultation, the patient has normal heart sounds and clear lung fields but with noted wheezing in bilateral bases upon expiration.
Differential Diagnosis
Chronic bronchitis - Chronic bronchitis is a progressive lung condition caused by the narrowing of lung airways and peripheral airway inflammation that leads to limitation in airflow and the destruction of lung vessels and tissues. When the severity of inflammation worsens, it leads to fibrosis in the airways and the production of exudates. There is also a reduction in airflow during exhalation leading to air trapping, which causes dyspnea (Gentry & Gentry, 2017).
Bronchiectasis - Bronchiectasis is the abnormal airway dilatation caused by a faulty immune response, damaged mucociliary clearance, recurrent bacterial infection, and airway obstruction. The combination of these eventually leads to compromised lung function (Gentry & Gentry, 2017).
Heart Failure - Heart failure occurs when the heart cannot provide enough blood flow that is required to supply the body. This is caused by damage or injury to the myocardium from conditions such as diabetes, hypertension, and ischemic heart disease (GOLD, 2017).
Analysis of the Differential Diagnoses
Based on the physical examination and history taking, the most probable diagnosis of the patient is chronic bronchitis. Primarily, the patient's clinical presentation matches the signs and symptoms expected to be seen from a chronic bronc...