Main Article: Bronchiectasis;

34 years old female complaining of cough with large amount of green sputum, shortness of breath associated with paroxysmal nocturnal dyspnea and orthopnea 5 years ago, condition was gradually progressive until 7 days ago that was enough to tolerate for the patient that is why she came to kasr al ainy hospital later with complaining of 13 kg weight loss within 2 months and vomiting, of course also previous symptoms like cough with sputum and dyspnea with clubbing of fingers. Clubbing of fingers is shown on the picture. 

On physical examination revealed: Chest deformities, epigastric pulsation, wheezing associated with rhonci and prolong expiration. Remember, patient had fever in the past. To understand this case, you read below article...

You must suspect the case is one of suppurative lung diseases through clinical presentation and patient history. Most probably bronchiectasis due to patient's symptoms and more common Egypt.
What is bronchiectasis ? Abnormal permanent dilatation of the bronchial tree of  the lung due to prolonged inflammation to bronchial tree caused by recurrent respiratory tract infections by bacterial organism e.g.  is defined as bronchiectasis.
Dilated bronchial tree filled with large amount of mucus including more bacteria  unable to clear mucus due to dilatation and damaged bronchial cilia as a result obstruction of airway of the lung.
Cough is not a disease nor pathologic symptom, it is a reflex in order to clear the mucus from bronchial tree and allowing airway opened. But production of mucus is progressive due to continuous inflammation  by infections. So always cough is present in order to clear mucus with dyspnea. Patient has clubbing of fingers due to hypoxia due to airway obstruction as a result of increased more blood supply to the peripheral parts of body including capillary nail bed leads to dilatation of nail bed results lost of window or angle is defined as clubbing of fingers, could be either parrot peak or drum streak, or 4th degree clubbing.

How to suspect the investigations ? From patient's symptoms, symptoms are selective for specific investigation. In this suspected case, High Resolution CT is the choice of investigation because it shows dilated bronchial tree and thickened wall. And also sputum culture for the selection of antibiotics.

Treatment :  It is always underlying cause then symptomatic treatment, if all fail, surgery is the option. Of Course for the severe dyspnea, patient needs Oxygen.