Severe persistent cough, worse in morning, with foul-smelling sputum sometimes bloody. Which condition?

• A. Bronchiectasis
• B. COPD
• C. Pneumonia
• D. Pulmonary edema

Answer: (A)

A chronic, severe productive cough with foul-smelling sputum that may be bloody points to bronchiectasis. In bronchiectasis, the airways are irreversibly dilated due to ongoing inflammation and infection, which disrupts normal mucus clearance. The retained mucus becomes a breeding ground for bacteria, leading to recurrent infections and a purulent, often malodorous sputum. Because mucus tends to accumulate overnight, symptoms frequently worsen in the morning. Bleeding can occur from eroded dilated bronchial vessels.

This pattern helps distinguish it from pneumonia, which is typically an acute, feverish consolidation; COPD, which involves chronic cough and dyspnea but not the characteristic foul-smelling sputum; and pulmonary edema, which presents with breathlessness, edema signs, and pink, frothy sputum rather than malodorous sputum.