In a patient with chronic cough, purulent sputum, and dilated airways seen on chest radiograph, what is the most likely diagnosis?

The symptoms presented—chronic cough, purulent sputum, and dilated airways on chest imaging—strongly suggest a diagnosis of bronchiectasis. This condition is characterized by the abnormal and permanent dilation of the bronchi, often resulting from recurrent airway infections or inflammatory processes. Patients with bronchiectasis commonly experience a chronic productive cough that may be accompanied by the production of thick, purulent sputum due to the persistent inflammation and infection in the airway walls. The chest radiograph typically reveals airway dilation and sometimes associated secretions.

In contrast to bronchiectasis, cystic fibrosis, while it can also cause chronic cough and purulent sputum, generally presents in a younger population and is associated with additional systemic symptoms such as malabsorption and failure to thrive due to pancreatic insufficiency.

Asthma primarily manifests with wheezing and dyspnea rather than significant purulent sputum, and airway obstruction is usually reversible. Chronic obstructive pulmonary disease (COPD) also presents with chronic cough and sputum production, but the sputum is usually not purulent in the way it is in bronchiectasis, and dilated airways are less characteristic of common COPD presentations compared to bronchiectasis.

Thus, the clinical presentation given aligns most