Progressive dyspnea, cough and mucopurulent sputum (903/1700)

A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of
mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking salbutamol, the ratio=2.4/3.7. What is the most likely dx?

a. Chronic bronchitis
b. Asthma
c. Bronchiectasis
d. Lung fibrosis
e. Sarcoidosis

































answer: C
It is not asthma because asthma will have an increase in FEV1 by at least 12%, here it increased about 5% indicating irreversible damage.

Differentiating chronic bronchitis and bronchiectasis is really not easy with this much information, since both can have cough, sputum, wheeze, dyspnea, hemoptysis, obstructive pattern. Usually in MCQs which point to bronchiectasis it will mention clubbing which generally isn't associated with COPD, also FOUL smelling sputum or history of severe pneumonia or disease predisposing to it or lack of smoking history can be clues for bronchiectasis.

However looking it at more closely, the lack of smoking history pushes me towards bronchiectasis.