Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chronic, productive cough, often associated with fatigue, malaise, and occasional hemoptysis. History is significant for long-standing indolent respiratory symptoms, often with a "Lady Windermere" phenotype (voluntary cough suppression). No constitutional symptoms of night sweats or significant weight loss. Symptoms are slowly progressive over months to years.
Clinical Examination Findings
General appearance: Patient is typically thin, often with a slender habitus. Chest auscultation: Focal or diffuse crackles, particularly in the right middle lobe or lingula. Percussion: Normal. Cardiac: Regular rhythm, no murmurs. Extremities: No clubbing or edema. Vital signs: Stable, afebrile.
Treatment Protocol
Treatment initiated with a multi-drug regimen: Clarithromycin (or Azithromycin), Rifampin, and Ethambutol. Airway clearance therapy (ACT) prescribed, including hypertonic saline nebulization and oscillating positive expiratory pressure (OPEP) devices. Monitoring: Baseline and serial visual acuity/color vision testing (for Ethambutol) and audiometry. Monthly sputum cultures for AFB to assess treatment response.